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Mechanical Chest Compressions and Simultaneous Defibrillation vs Conventional Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest The LINC Randomized Trial
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
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2014 (English)In: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 311, no 1, 53-61 p.Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
2014. Vol. 311, no 1, 53-61 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-216731DOI: 10.1001/jama.2013.282538ISI: 000329161400018OAI: oai:DiVA.org:uu-216731DiVA: diva2:691187
Available from: 2014-01-27 Created: 2014-01-24 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Mechanical chest compressions and gender differences in out-of-hospital-cardiac-arrest
Open this publication in new window or tab >>Mechanical chest compressions and gender differences in out-of-hospital-cardiac-arrest
2016 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Paper I and II. Both early defibrillation and high quality chest compressions are affecting the chances of survival after cardiac arrest (CA). Manual chest compressions delivers only approximately 30% of normal cardiac output and is further deteriorating during transport. Mechanical chest compressions has in experimental studies delivered higher perfusion pressures, cerebral blood flow and end-tidal CO2 compared to manual CPR. Two pilot studies showed no difference in outcome compared to manual CPR. The LINC trial was the first large randomized trial testing the effectiveness and safety of mechanical chest compressions compared to manual CPR. The objectives were to determine whether CPR with mechanical chest compression and defibrillation during ongoing CPR, compared with CPR with manual chest compressions, according to guidelines, would improve 4-hour survival after out-of-hospital cardiac arrest (OHCA).
We could not identify any significant differences in outcome between the two groups.

Paper III. Despite women having several adverse characteristics associated with bad outcome after CA, female gender is considered being an independent predictor for early survival. This is however no longer seen after the initial phase, when male survival is significantly higher. The reason for this difference is not known. This has previously been shown in register based studies. This is, to our best knowledge, the first analysis based on a population from a randomized controlled trial. We aimed to identify gender differences in survival after OHCA.
Female gender was an independent predictor for early survival, but this difference was no longer seen at hospital discharge or after 6 months. 

Place, publisher, year, edition, pages
Uppsala: Uppsala universitet, 2016. 46 p.
National Category
Medical and Health Sciences
Research subject
Anaesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-303994 (URN)
Presentation
2016-10-20, Akademiska sjukhuset, lärarrummet, ing 70, Akademiska sjukhuset, Uppsala, 14:20
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Available from: 2016-09-29 Created: 2016-09-28 Last updated: 2016-09-29Bibliographically approved

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Rubertsson, StenLindgren, ErikSmekal, DavidKarlsten, Rolf

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