Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised controlled trial

Perkins, Gavin D.; Lall, Ranjit; Quinn, Tom; Deakin, Charles D.; Cooke, Matthew; Horton, Jessica; Lamb, Sarah E; Slowther, Anne‐Marie; Woollard, Malcolm; Carson, Andy; Smyth, Michael A.; Whitfield, Richard; Williams, Amanda; Pocock, Helen; Black, John J.; Wright, John; Han, Kyee; Gates, Simon

doi:10.1016/s0140-6736(14)61886-9

Cited by 397 publications

(315 citation statements)

References 26 publications

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“…[8] The population reported in this trial is larger than that reported in the PARAMEDIC trial as it includes patients assessed during the set up phase of the trial. The PARAMEDIC trial was registered on the International Standard Randomised Controlled Trial Number Registry (ISRCTN08233942) and received ethical approval from Coventry Resarch Ethics Committee: 09/H1210/69.…”

Section: Methodsmentioning

confidence: 99%

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Characteristics of patients who are not resuscitated in out of hospital cardiac arrests and opportunities to improve community response to cardiac arrest

et al. 2016

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NoDerivatives 4.0 International http://creativecommons.org/about/downloadsCharacteristics of patients who are not resuscitated in out of hospital cardiac arrests and opportunities to improve community response to cardiac arrest Rajagopal S [a,b] Methods: This a secondary analysis of unselected patients who sustained an out of hospital cardiac arrest attended by ambulance vehicles participating in a randomized controlled trial of a mechanical chest compression device (PARAMEDIC trial). Patients were categorized as 'non-resuscitation' patients if there was a do-not-attempt-cardiopulmonary-resuscitation (DNACPR) order, signs unequivocally associated with death or resuscitation was deemed futile (15 minutes had elapsed since collapse with no bystander-CPR and asystole recorded on EMS arrival).Results:Emergency Medical Services attended 11,451 cardiac arrests. Resuscitation was attempted or continued by Emergency Medical Service staff in 4,805 (42%) of cases. Resuscitation was withheld in 6,646 cases (58%). Of these, 711 (6.2%) had a do not attempt resuscitation decision, 4439 (38.8%) had signs unequivocally associated with death and in 1496 cases (13.1%) CPR was considered futile. Those where resuscitation was withheld due to futility were characterised by low bystander CPR rates (7.2 %) and by being female. Conclusions:Resuscitation was withheld by ambulance staff in over one in ten (13.1%) victims of out of hospital cardiac arrest on the basis of futility. These cases were associated with a very low rate of bystander CPR. Future studies should explore strengthening the 'Chain of Survival' to increase the community bystander CPR response and evaluate the effect on the number of survivors from out of hospital cardiac arrest.

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Section: Methodsmentioning

confidence: 99%

“…[8] The trial utilised 91 ambulance stations across four UK National Health Service (NHS) Ambulance Services. Ambulance vehicles were randomized to deliver manual cardiopulmonary resuscitation (CPR) or the LUCAS-2 device (Lund University Cardiopulmonary Assistance System) to eligible patients.…”

Section: Settingmentioning

confidence: 99%

Characteristics of patients who are not resuscitated in out of hospital cardiac arrests and opportunities to improve community response to cardiac arrest

et al. 2016

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“…For the purpose of this review, we measured the baseline (or first) time point for describing healthrelated quality of life as reported by individual studies; conventionally in trial-based economic evaluations this is taken as the time of randomisation. Nine (47%) of the 19 studies used the EQ-5D to measure health-related quality of life of patients, 5 (26%) used the EQ-5D in combination with another instrument (primarily the SF-12/36 [26,33,35], HUI-3 [32] and the paediatric PedsQL [36]), 1 (5%) [18] used the 15D instrument [34] and another 1 (5%) used the HUI-3 [28]. The remaining 3 (17%) studies [29] [25,27] did not report a primary health-related quality of life data collection process.…”

Section: Measurement Of Health-related Quality Of Lifementioning

confidence: 99%

“…The most obvious limitation is that it is not possible to obtain direct estimates from deceased or permanently incapacitated patients (who would not be missing at random). For example, in the PARAMEDIC 1 trial [35], only 6.6% of 1471 individuals experiencing out-of-hospital cardiac arrest recruited into the trial survived to 3 months post arrest, the first time point at which health-related quality of life data were collected. Asking patients to retrospective recall their baseline health-related quality of life would not be an option for the majority of this trial's participants.…”

Section: Retrospective Recall Of the Baseline Health-related Quality mentioning

confidence: 99%

Methodological Issues Surrounding the Use of Baseline Health-Related Quality of Life Data to Inform Trial-Based Economic Evaluations of Interventions Within Emergency and Critical Care Settings: A Systematic Literature Review

et al. 2017

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warwick.ac.uk/lib-publicationsOriginal citation: Dritsaki, Melina, Achana, Felix A., Mason, James and Petrou, Stavros. (2017) Methodological issues surrounding the use of baseline health-related quality of life data to inform trial-based economic evaluations of interventions within emergency and critical care settings : a systematic literature review. PharmacoEconomics. Permanent WRAP URL:http://wrap.warwick.ac.uk/85039 Copyright and reuse:The Warwick Research Archive Portal (WRAP) makes this work by researchers of the University of Warwick available open access under the following conditions. Copyright © and all moral rights to the version of the paper presented here belong to the individual author(s) and/or other copyright owners. To the extent reasonable and practicable the material made available in WRAP has been checked for eligibility before being made available.Copies of full items can be used for personal research or study, educational, or not-for profit purposes without prior permission or charge. Provided that the authors, title and full bibliographic details are credited, a hyperlink and/or URL is given for the original metadata page and the content is not changed in any way. Publisher's statement:"The final publication is available at Springer via http://dx.doi.org/10.1007/s40273-016-0485-x " A note on versions:The version presented here may differ from the published version or, version of record, if you wish to cite this item you are advised to consult the publisher's version. Please see the 'permanent WRAP url' above for details on accessing the published version and note that access may require a subscription. Results: A total of 4224 published reports were screened, 19 of which met the study inclusion criteria (mean trial size 1,670); 14 (74 %) from the UK, 4 (21%) from other European countries and 1 (5%) from India. Twelve studies (63%) were based in emergency departments and 7 (37%) in intensive care units. Only one study was able to elicit patient-reported health-related quality of life at baseline. To overcome the lack of baseline data when estimating QALYs, 8 (42%) studies assigned a fixed utility weight corresponding to either death, an unconscious health state or a country-specific norm to patients at baseline, 4 (21%) ignored baseline utilities, 3 (16%) applied values from another study, 1 (5%) generated utility values via retrospective recall and 1 (5%) elicited utilities from experts. A preliminary exploration of these methods shows that incremental QALY estimation is unlikely to be biased if balanced trial allocation is achieved and subsequent collection of health-related quality of life data occurs at the earliest possible opportunity following commencement of treatment followed by adequate number of follow-up assessments. Conclusion:Trial-based cost-utility analyses within emergency and critical illness settings have applied different methods for QALY estimation, employing disparate assumptions about the health-related quality of life of patients at baseline. Where baseline measurem...

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“…16,17 Conventional manual chest compressions remain the standard of care for the treatment of cardiac arrest, but mechanical chest compression devices may be a reasonable alternative for use by properly trained personnel. [18][19][20] When rapidly implemented, extracorporeal cardiopulmonary resuscitation (ECPR) can prolong viability for patients who are not resuscitated with conventional CPR. ECPR can provide time to treat potentially reversible conditions or arrange cardiac transplantation.…”

Section: Advanced Life Support-adultmentioning

confidence: 99%

What is new in the 2015 American Heart Association guidelines, what is recycled from 2010, and what is relevant for emergency medicine in Canada

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Caen

Bhanji

et al. 2016

CJEM

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Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised controlled trial

Abstract: National Institute for Health Research HTA - 07/37/69.

Cited by 397 publications

References 26 publications

Characteristics of patients who are not resuscitated in out of hospital cardiac arrests and opportunities to improve community response to cardiac arrest

Characteristics of patients who are not resuscitated in out of hospital cardiac arrests and opportunities to improve community response to cardiac arrest

Methodological Issues Surrounding the Use of Baseline Health-Related Quality of Life Data to Inform Trial-Based Economic Evaluations of Interventions Within Emergency and Critical Care Settings: A Systematic Literature Review

What is new in the 2015 American Heart Association guidelines, what is recycled from 2010, and what is relevant for emergency medicine in Canada

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