Mechanical chest compressions and simultaneous defibrillation vs conventional cardiopulmonary resuscitation in out-of-hospital cardiac arrest: the LINC randomized trial.

Abstract

IMPORTANCE:

A strategy using mechanical chest compressions might improve the poor outcome in out-of-hospital cardiac arrest, but such a strategy has not been tested in large clinical trials.

OBJECTIVE:

To determine whether administering mechanical chest compressions with defibrillation during ongoing compressions (mechanical CPR), compared with manual cardiopulmonary resuscitation (manual CPR), according to guidelines, would improve 4-hour survival.

DESIGN, SETTING, AND PARTICIPANTS:

Multicenter randomized clinical trial of 2589 patients with out-of-hospital cardiac arrest conducted between January 2008 and February 2013 in 4 Swedish, 1 British, and 1 Dutch ambulance services and their referring hospitals. Duration of follow-up was 6 months.

INTERVENTIONS:

Patients were randomized to receive either mechanical chest compressions (LUCAS Chest Compression System, Physio-Control/Jolife AB) combined with defibrillation during ongoing compressions (n = 1300) or to manual CPR according to guidelines (n = 1289).

MAIN OUTCOMES AND MEASURES:

Four-hour survival, with secondary end points of survival up to 6 months with good neurological outcome using the Cerebral Performance Category (CPC) score. A CPC score of 1 or 2 was classified as a good outcome.

RESULTS:

Four-hour survival was achieved in 307 patients (23.6%) with mechanical CPR and 305 (23.7%) with manual CPR (risk difference, -0.05%; 95% CI, -3.3% to 3.2%; P > .99). Survival with a CPC score of 1 or 2 occurred in 98 (7.5%) vs 82 (6.4%) (risk difference, 1.18%; 95% CI, -0.78% to 3.1%) at intensive care unit discharge, in 108 (8.3%) vs 100 (7.8%) (risk difference, 0.55%; 95% CI, -1.5% to 2.6%) at hospital discharge, in 105 (8.1%) vs 94 (7.3%) (risk difference, 0.78%; 95% CI, -1.3% to 2.8%) at 1 month, and in 110 (8.5%) vs 98 (7.6%) (risk difference, 0.86%; 95% CI, -1.2% to 3.0%) at 6 months with mechanical CPR and manual CPR, respectively. Among patients surviving at 6 months, 99% in the mechanical CPR group and 94% in the manual CPR group had CPC scores of 1 or 2.

CONCLUSIONS AND RELEVANCE:

Among adults with out-of-hospital cardiac arrest, there was no significant difference in 4-hour survival between patients treated with the mechanical CPR algorithm or those treated with guideline-adherent manual CPR. The vast majority of survivors in both groups had good neurological outcomes by 6 months. In clinical practice, mechanical CPR using the presented algorithm did not result in improved effectiveness compared with manual CPR.

TRIAL REGISTRATION:

clinicaltrials.gov Identifier: NCT00609778.

• Authors: Sten Rubertsson, Erik Lindgren, David Smekal, Ollie Östlund, Johan Silfverstolpe, Robert A Lichtveld, Rene Boomars, Björn Ahlstedt, Gunnar Skoog, Robert Kastberg, David Halliwell, Martyn Box, Johan Herlitz, Rolf Karlsten
• Journal: JAMA (JAMA) Vol. 311 Issue 1 Pg. 53-61 (Jan 01 2014) ISSN: 1538-3598 [Electronic] United States
• PMID: 24240611 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Cardiopulmonary Resuscitation (methods)
• Electric Countershock
• Emergency Medical Services
• Female
• Humans
• Male
• Middle Aged
• Out-of-Hospital Cardiac Arrest (complications, physiopathology, therapy)
• Practice Guidelines as Topic
• Survival Analysis
• Young Adult