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  • Rubertsson, StenUppsala universitet,Anestesiologi och intensivvård (author)

Mechanical chest compressions and simultanous defibrillationvs conventional cardiopulmonary resuscitationin out-of hospital cardiac arrest:the LINC randomized trial

  • Article/chapterEnglish2014

Publisher, publication year, extent ...

  • American Medical Association,2014
  • printrdacarrier

Numbers

  • LIBRIS-ID:oai:DiVA.org:hb-1985
  • https://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-1985URI
  • https://doi.org/10.1001/jama.2013.282538DOI
  • https://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-1663URI
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-216731URI

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  • Language:English
  • Summary in:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • 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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  • Lindgren, ErikUppsala universitet,Anestesiologi och intensivvård(Swepub:uu)erili635 (author)
  • Smekal, DavidUppsala universitet,Anestesiologi och intensivvård(Swepub:uu)davsm531 (author)
  • Östlund, OllieUppsala universitet,Uppsala kliniska forskningscentrum (UCR)(Swepub:uu)oos27600 (author)
  • Silverstolpe, Johan (author)
  • Lichtveld, Robert A (author)
  • Boomars, Rene (author)
  • Ahlstedt, Björn (author)
  • Skoog, Gunnar (author)
  • Kastberg, Robert (author)
  • Halliwell, David (author)
  • Box, Martyn (author)
  • Herlitz, JohanHögskolan i Borås,Institutionen för Vårdvetenskap,Prehospital akutsjukvård(Swepub:hb)jhz (author)
  • Karlsten, RolfUppsala universitet,Anestesiologi och intensivvård(Swepub:uu)rolfkarl (author)
  • Smekal, E (author)
  • Skoog, B (author)
  • Uppsala universitetAnestesiologi och intensivvård (creator_code:org_t)

Related titles

  • In:Journal of the American Medical Association (JAMA): American Medical Association311:1, s. 53-610098-74841538-3598

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