Original Investigation |

Mechanical Chest Compressions and Simultaneous Defibrillation vs Conventional Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest:  The LINC Randomized Trial

Sten Rubertsson, MD, PhD1; Erik Lindgren, MD1; David Smekal, MD, PhD1; Ollie Östlund, PhD2; Johan Silfverstolpe, MD3; Robert A. Lichtveld, MD, PhD4; Rene Boomars, MPA4; Björn Ahlstedt, MD5; Gunnar Skoog, MD6; Robert Kastberg, MD6; David Halliwell, RN7; Martyn Box, RN7; Johan Herlitz, MD, PhD8; Rolf Karlsten, MD, PhD1
[+] Author Affiliations
1Department of Surgical Sciences/Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
2Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
3Region Skåne Prehospital Center and Skåne University Hospital, Lund, Sweden
4Regional Ambulance Service Utrecht, Utrecht, Netherlands
5Västerås Central Hospital, Västerås, Sweden
6Gävle Hospital, Gävle, Sweden
7South Western Ambulance Service NHS Foundation Trust Abbey Court, Exeter, England
8Center of Prehospital Research in Western Sweden and the University College of Borås and Sahlgrenska University Hospital, Göteborg, Sweden
JAMA. 2014;311(1):53-61. doi:10.1001/jama.2013.282538.
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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

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Figure 1.
Description of Study Intervention Algorithms

Ventilation and medication were given according to guidelines16 in both groups. VF indicates ventricular fibrillation; VT, ventricular tachycardia; and PEA, pulseless electrical activity.

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Figure 2.
Participant Flow

CPR indicates cardiopulmonary resuscitation.aAn unknown number of patients were excluded who had crew-witnessed ventricular fibrillation/ventricular tachycardia and return of spontaneous circulation at first defibrillation.

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