To evaluate the magnitude of the difference in VO2peak between patients with Chronic Fatigue Syndrome/ Myalgic Encephalomyelitis (CFS/ME) and apparently healthy controls, 7 databases (Cochrane, PubMed, PsycINFO, Web of Knowledge, Embase, Scopus, Medline) were searched for articles published up to March 2018. Search terms included “chronic fatigue syndrom*”AND (“peak” OR “maxim*” OR “max”) AND (“oxygen uptake” OR “oxygen consumption” OR “VO2peak” or “VO2max”. Eligibility criteria were adults>18 y with clinically diagnosed CFS/ME, with VO2peak measured in a maximal test and compared against an apparently healthy control group. The methodological quality of included studies was assessed using a modified Systematic Appraisal of Quality for Observational Research critical appraisal framework. A random effects meta-analysis was conducted on 32 cross-sectional studies (effects). Pooled mean VO2peak was 5.2 (95% CI: 3.8–6.6) ml.kg−1min−1 lower in CFS/ME patients vs. healthy controls. Between-study variability (Tau) was 3.4 (1.5–4.5) ml.kg−1min−1 indicating substantial heterogeneity. The 95% prediction interval was −1.9 to 12.2 ml.kg−1min−1. The probability that the effect in a future study would be>the minimum clinically important difference of 1.1 ml.kg−1min−1 (in favour of controls) was 0.88 – likely to be clinically relevant. Synthesis of the available evidence indicates that CFS/ME patients have a substantially reduced VO2peak compared to controls.

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ObjectivesWe set out to investigate paramedics’ views of ethics and research, drawing on experiences from Paramedic-2, a randomised controlled trial comparing epinephrine and placebo in out-of-hospital cardiac arrest (OHCA).MethodsAn interpretative phenomenological approach was adopted. A purposive sample of paramedics (n=6) from North East Ambulance Service NHS Foundation Trust were invited to a semi-structured, in-depth interview.ResultsThree superordinate themes emerged: (1) morality, (2) emotion and (3) equipoise. Some viewed Paramedic-2 as an opportunity to improve OHCA outcomes for the many, viewing participation as a moral obligation; others viewed the study as unethical, equating participation with immoral behaviour. Morality was a motivator to drive individual action. Positive and negative emotions were exhibited by the paramedics involved reflecting the wider view each paramedic held about trial participation. Those morally driven to participate in Paramedic-2 discussed their pride in being associated with the trial, while those who found participation unethical, discussed feelings of guilt and regret. Individual experience and perceptions of epinephrine guided each paramedic’s willingness to accept or reject equipoise. Some questioned the role of epinephrine in OHCA; others believed withholding epinephrine was synonymous to denying patient care.ConclusionA paucity of evidence exists to support any beneficial role of epinephrine in OHCA. Despite this, some paramedics were reluctant to participate in Paramedic-2 and relied on their personal perceptions and experiences of epinephrine to guide their decision regarding participation. Failure to acknowledge the importance of individual perspectives may jeopardise the success of future out-of-hospital trials.

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Advances in cardiac arrest management have led to the use of a mechanical chest compression device in an attempt to improve outcomes in cardiopulmonary resuscitation (CPR). This systematic review set out to identify whether the inclusion of the mechanical device improves survival rates in the cardiac arrest patient within the emergency setting, and explored the themes: training, environment and time of device deployment. The systematic review measured the value of mechanical chest compression devices versus standard manual compressions in respect to resuscitation outcomes (return of spontaneous circulation). Ten studies with data from 12 894 adult patients, who presented with out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA), were included. Results demonstrated an equality between manual and mechanical CPR with a statistical increase in survival when the mechanical device is used. Training, time of deployment, guideline adherence and timing of rhythm check/defibrillation presented challenges in the analysis of the data.