EBQ:Paramedic Trial

Under Review Journal Club Article

Perkins GD. et al.. "Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised controlled trial". Lancet. 2015. 385(9972):947-55.
PubMed Full text PDF

Clinical Question

Does prehospital LUCAS-2 mechanical CPR improve survival from out-of-hospital cardiac arrest?

Conclusion

The use of LUCAS-2 in non-traumatic, out-of-hospital cardiac arrests did not show improvement over manual CPR in patient survival to 30 days.

Major Points

• Survival to 30 days had no difference with 6% (LUCAS-2) vs. 7% (control)
• No difference in ROSC, survival of event, survival to 3 months, or survival to 12 months
• Decreased favorable neurologic outcome (CPC 1 or 2) in LUCAS-2 group

Study Design

Pragmatic, cluster randomized, controlled trial

Population

91 ambulance stations (selected for being urban and semi-urban) from 4 UK National Health Service (NHS) Ambulance Services (West Midlands, North East England, Wales, South Central).

Patient Demographics

• No major differences in baseline characteristics
  • Mean age ~71 years
  • 63% male
  • ~87% presumed cardiac etiology
  • ~82% arrests occurred at home
  • ~62% witnessed arrests
  • ~44% bystander CPR performed before EMS arrival
  • ~6.4 minute response time from call to EMS arrival
  • ~82% given IV medications
  • ~46% intubated
  • ~67% transported to hospital

Inclusion Criteria

• Vehicle included in trial is first on scene
• Patient in cardiac arrest outside of a hospital
• Resuscitation attempted
• Known or believed to be ≥18 years of age

Exclusion Criteria

• Cardiac arrest caused by trauma
• Known or apparent pregnancy

See Also

LINC Trial

Sources

Authors

Catie Reynolds, Daniel Ostermayer