The cost-effectiveness of a mechanical compression device in out-of-hospital cardiac arrest

Marti, Joachim; Hulme, Claire; Ferreira, Zenia; Nikolova, Silviya; Lall, Ranjit; Kaye, Charlotte; Smyth, Michael A.; Kelly, Charlotte; Quinn, Tom; Gates, Simon; Deakin, Charles D.; Perkins, Gavin D.

doi:10.1016/j.resuscitation.2017.04.036

Cited by 27 publications

(17 citation statements)

References 35 publications

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“… 19–22 Moreover, an analysis of the cost-effectiveness of the use of mechanical compression devices in OHCA showed that they were more costly and less effective than manual chest compressions. 23 Therefore, further studies are needed to evaluate the routine use of mechanical devices in OHCA.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the quality of cardiopulmonary resuscitation according to vehicle driving pattern, using a virtual reality ambulance driving system: a prospective, cross-over, randomised study

et al. 2018

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ObjectivesTo analyse changes in the quality of cardiopulmonary resuscitation (CPR) according to driving patterns encountered during ambulance transport, using a virtual reality simulator.DesignProspective, cross-over, randomised study.SettingThis study was conducted at the National Fire Service Academy, Cheonan-si, Korea.ParticipantsEmergency medical technicians (39 men and 9 women) attending the National Fire Service Academy for clinical training with ≥6 months field experience or having performed ≥10 CPR. Individuals who withdrew consent were excluded.Outcome measuresCPR quality parameters (eg, chest compression depth and its variability).ResultsChest compressions were performed for 8 min each in a stationary and driving state. The mean chest compression depths were 54.8 mm and 55.3 mm during these two states, respectively (p=0.41). The SD of the chest compression depth was significantly higher while in the driving (7.6 mm) than in the stationary state (6.5 mm; p=0.04). The compression depths in the speed bump and sudden stop sections were 51.5 mm and 50.6 mm, respectively, which was shallower than those in all other sections (p<0.001). The correct hand position rate was low in the speed bump, sudden stop and right-hand cornering sections (65.4%, 71.5% and 72.5%, respectively; p=0.001)ConclusionsAlthough we found no differences in chest compression quality parameters between the stationary and driving states, the variability in the chest compression depth increased in the driving state. When comparing CPR quality parameters according to driving patterns, we noted a shallower compression depth, increased variability and decreased correct hand position rate in the speed bump, sudden stop and right-hand cornering sections. The clinical significance of these changes in CPR quality during ambulance transport remains to be determined. Future studies on how to reduce changes in the quality of CPR (including research on equipment development) are needed.

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Section: Discussionmentioning

confidence: 99%

Evaluation of the quality of cardiopulmonary resuscitation according to vehicle driving pattern, using a virtual reality ambulance driving system: a prospective, cross-over, randomised study

et al. 2018

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“…The long-term (up to 12 months) outcome analysis found no clinically important differences between groups in relation to outcomes such as survival, neurological outcome, and quality of life at 3 months and 12 months, although the analysis was subject to a high risk of attrition bias [ 24 ]. The cost-effectiveness analysis found that routine use of mechanical CPR devices in the out-of-hospital setting was not cost-effective [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

Mechanical CPR: Who? When? How?

et al. 2018

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In cardiac arrest, high quality cardiopulmonary resuscitation (CPR) is a key determinant of patient survival. However, delivery of effective chest compressions is often inconsistent, subject to fatigue and practically challenging.Mechanical CPR devices provide an automated way to deliver high-quality CPR. However, large randomised controlled trials of the routine use of mechanical devices in the out-of-hospital setting have found no evidence of improved patient outcome in patients treated with mechanical CPR, compared with manual CPR. The limited data on use during in-hospital cardiac arrest provides preliminary data supporting use of mechanical devices, but this needs to be robustly tested in randomised controlled trials.In situations where high-quality manual chest compressions cannot be safely delivered, the use of a mechanical device may be a reasonable clinical approach. Examples of such situations include ambulance transportation, primary percutaneous coronary intervention, as a bridge to extracorporeal CPR and to facilitate uncontrolled organ donation after circulatory death.The precise time point during a cardiac arrest at which to deploy a mechanical device is uncertain, particularly in patients presenting in a shockable rhythm. The deployment process requires interruptions in chest compression, which may be harmful if the pause is prolonged. It is recommended that use of mechanical devices should occur only in systems where quality assurance mechanisms are in place to monitor and manage pauses associated with deployment.In summary, mechanical CPR devices may provide a useful adjunct to standard treatment in specific situations, but current evidence does not support their routine use.

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“…Trial recruitment ran from 15 April 2010 to 10 June 2013. We have previously reported primary outcome (30-day survival), 10 secondary outcomes, 11 an economic analysis 12 and characteristics of patients who were not resuscitated. 13 …”

Section: Methodsmentioning

confidence: 99%

“…We used the MINAP, NAPCI and CMP data for the health economic analysis 12 and long-term postadmission outcomes 11 and to validate the hospital length of stay or stay in the intensive care (secondary outcomes for the efficacy part of the trial) and also to gain insight into the specifics of the treatment or procedures that trial patients received during their hospital stay. Characteristics of the registries are summarised in table 1 .…”

Section: Methodsmentioning

confidence: 99%

Feasibility of data linkage in the PARAMEDIC trial: a cluster randomised trial of mechanical chest compression in out-of-hospital cardiac arrest

Quinn

Gavalova

et al. 2018

BMJ Open

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Objectives There is considerable interest in reducing the cost of clinical trials. Linkage of trial data to administrative datasets and disease-specific registries may improve trial efficiency, but it has not been reported in resuscitation trials conducted in the UK. To assess the feasibility of using national administrative and clinical datasets to follow up patients transported to hospital following attempted resuscitation in a cluster randomised trial of a mechanical chest compression device in out-of-hospital cardiac arrest. Methods Hospital data on trial participants were requested from Hospital Episode Statistics (HES), the Intensive Care National Audit and Research Centre, and Myocardial Ischaemia National Audit Project and National Audit of Percutaneous Coronary Interventions, using unique patient identifiers. Linked data were received between June 2014 and June 2015. Results Of 4471 patients randomised in the pre-hospital randomised assessment of a mechanical compression device in cardiac arrest (PARAMEDIC) trial, 2398 (53.6%) were not known to be deceased at emergency department arrival and were eligible for linkage. We achieved an overall match rate of 86.7% in the combined HES accident and emergency, inpatient and critical care dataset, with variable match rates (4.2%–80.4%) in individual datasets. Patient demographics, cardiac arrest-related characteristics and major outcomes were predominantly similar between HES matched and unmatched groups, in the linkage apart from location, response time and return of spontaneous circulation (ROSC) at handover. Conclusions This study shows that it is feasible to track patients from the prehospital setting through to hospital admission using routinely available administrative datasets with a moderate to high degree of success. This approach has the potential to complement the trial data with the demographic and clinical management information about the studied cohort, as well as to improve the efficiency and reduce the costs of follow-up in cardiac arrest trials. Clinical trial registration NCT08233942Post-results.

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The cost-effectiveness of a mechanical compression device in out-of-hospital cardiac arrest

Abstract: Our study demonstrates that the use of the mechanical chest compression device LUCAS-2 represents poor value for money when compared to standard manual chest compression in out-of-hospital cardiac arrest.

Cited by 27 publications

References 35 publications

Evaluation of the quality of cardiopulmonary resuscitation according to vehicle driving pattern, using a virtual reality ambulance driving system: a prospective, cross-over, randomised study

Evaluation of the quality of cardiopulmonary resuscitation according to vehicle driving pattern, using a virtual reality ambulance driving system: a prospective, cross-over, randomised study

Mechanical CPR: Who? When? How?

Feasibility of data linkage in the PARAMEDIC trial: a cluster randomised trial of mechanical chest compression in out-of-hospital cardiac arrest

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