Background
The importance of high quality CPR
Current treatment recommendations
Out-of-hospital cardiac arrest
Routine deployment in OHCA
Load-distributing band trials | Piston-device trials | ||||
---|---|---|---|---|---|
Hallstrom et al. [20]a | CIRC [17] | Smekal et al. [21] | LINC [18] | PARAMEDIC [19] | |
Design | Efficacy superiortity multicentre RCT | Efficacy equivalence multicentre RCT | Pilot multicentre RCT | Efficacy superiority multicentre RCT | Effectiveness superiority multicentre RCT |
Randomisation | Cluster- EMS station(s) (ratio 1:1) | Patient (ratio 1:1) | Patient (ratio 1:1) | Patient (ratio 1:1) | Cluster- ambulance (ratio 2 manual:1 mechanical) |
Inclusion criteria | Adult non-traumatic OHCA | Adult OHCA of cardiac aetiology. EMS arrival time ≤ 16 min | Adult non-traumatic OHCA | Adult unexpected non-traumatic OHCA where resuscitation was appropriate | Adult non-traumatic OHCA where a trial vehicle was first ambulance on scene |
Number of cases analysed | 1071 (1071 randomised) | 4231 (4753 randomised) | 149 | 2589 (2593 randomised) | 4470 (4471 randomised) |
Setting | US/Canada | US /Europe | Sweden | Europe | UK |
Sponsor | Industry | Industry | Academicb | Industry | Academic |
Device used | Autopulse | Autopulse | LUCAS | LUCAS | LUCAS |
Primary outcome | 4-h survival: Manual 29.5% vs mechanical 28.5%, p = 0.74 | STD Manual 11.0% vs mechanical 9.4%, adj. OR 1.06 (95% CI 0.83, 1.37)c | Not specified | 4-h survival Manual 23.7% vs mechanical 23.6%, treatment difference − 0.05 (95% CI − 3.3, 3.2) | 30-day survival Manual 7% vs mechanical 6%, adj. OR 0.86 (95% CI 0.64, 1.15) |
Key secondary outcomes | Cardiac aetiology group (n = 767): STD: Manual 9.9% vs mechanical 5.8%, p = 0.06 (adjusted) Good neurological outcome: Manual 7.5% vs mechanical 3.1%, p = 0.006 | Sustained ROSC: Manual 32.3% vs mechanical 28.6%, adj. OR 0.84 (95% CI 0.73, 0.96) Good neurological outcome in survivors: Manual 48.1% vs mechanical 44.4%, adj. OR 0.80 (95% CI 0.47, 1.37) | ROSC: Manual 32% vs mechanical 41%, p = 0.30 STD: Manual 10% vs mechanical 8%, p = 0.78 | STD: Manual 9.2% vs mechanical 9.0%, treatment difference − 0.15 (95% CI − 2.4, 2.1) Good neurological outcome: Manual 7.3% vs mechanical 8.1%, treatment difference 0.78 (95% CI − 1.3, 2.8) | ROSC: Manual 31% vs mechanical 32%, adj. OR 0.99 (95% CI 0.86, 1.14) Good neurological outcome: Manual 6% vs mechanical 5%, adj. OR 0.72 (95% CI 0.52, 0.99) |
Use during transfer to hospital
Use in the emergency department
In-hospital cardiac arrest
Load-distributing band trials | Piston-device trials | ||
---|---|---|---|
Halperin et al. [44] | Taylor et al. [43] | Lu et al. [42]a | |
Design | Efficacy superiortity single-centre RCT | Efficacy superiortity single-centre RCT | Efficacy superiority single-centre RCT |
Randomisation | Patient (ratio 1:1) | Patient (ratio 1:1) | Patient (ratio 1:1) |
Inclusion criteria | IHCA of less than 20-min duration following tracheal intubation and adrenaline administration | IHCA of less than 10-min duration | IHCA of less than 10-min duration |
Number of cases analysed | 34 | 50 | 150 |
Setting | US | US | China |
Sponsor | Academicb | Academic | Unclear |
Device used | Load-distributing band device | Thumper device | Thumper device |
Primary outcome | ROSC Manual 18% vs mechanical 47%, OR 4.15 (95% CI 0.86, 19.92) | One-hour survival Manual 38% vs mechanical 42%, OR 1.14 (95% CI 0.37, 3.55) | STD Manual 15% vs mechanical 33%, OR 2.81 (95% CI 1.26, 6.24) |
Key secondary outcomes | 24-h survival: Manual 6% vs mechanical 18% | STD: Manual 8% vs mechanical 13%, OR 1.71 (95% CI 0.26, 11.26) | ROSC: Manual 38% vs mechanical 55%, OR 2.03 (95% CI 1.06, 3.90) |