Mechanical Chest Compressions and Simultaneous Defibrillation vs Conventional Cardiopulmonary Resuscitation in Out of Hospital CA: The LINC Randomized Trial.

Sten Rubertsson, MD, PhD; Erik Lindgren, MD; David Smekal, MD, PhD; Ollie Östlund, PhD; Johan Silfverstolpe, MD; Robert A. Lichtveld, MD, PhD; Rene Boomars, MPA; Björn Ahlstedt, MD; Gunnar Skoog, MD; Robert Kastberg, MD; David Halliwell, RN; Martyn Box, RN; Johan Herlitz, MD, PhD; Rolf Karlsten, MD, PhD
JAMA. doi:10.1001/jama.2013.282538

LINK TO STUDY

This is an important and well done study that again could not find any improvement with outcomes with the use of a mechanical chest compression device.

 This is a multicenter randomized clinical trial of 2589 patients with out-of-hospital cardiac arrest that compared outcomes between the LUCAS device and conventional CPR. The outcomes were survival at 4 hours, survival at 6 months, and level of function (CPC score). There was no difference noted between these two groups.  The LUCAS device did not improve ROSC, survival, or CPC scores.

 Four-hour survival

  • 23.6% with mechanical CPR

  • 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

  • 7.5% with mechanical CPR

  • 6.4% with manual CPR (risk difference, 1.18%; 95%CI, –0.78%to 3.1%)

Survival at 6 months

  • 8.5% with mechanical CPR

  • 7.6% with manual CPR (risk difference, 0.86%; 95%CI, –1.2%to 3.0%)

  • I have yet to meet a firefighter paramedic or EMT who did not love their LUCAS or Autopulse device.

  • We see how well it performs precise and consistent chest compressions, never gets tired, and performs well in the back of a moving ambulance.

  • Our hospital experience in the catheterization labs has demonstrated excellent mean arterial pressures and pulses.

  • Still, this is the second or third well designed randomized study demonstrating no survival or neurological benefit.

Alameda County has analyzed our cardiac arrest survival as compared to prior years and similarly demonstrated no improvement in survival.  We did find a tantalizing improvement in CPC scores that we hope will remain statistically and clinically significant.

Dr. Sporer is the EMS Medical Director for Alameda County

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