The Study Protocol for the LINC (LUCAS in Cardiac Arrest) Study: a study comparing conventional adult out-of-hospital cardiopulmonary resuscitation with a concept with mechanical chest compressions and simultaneous defibrillation

Rubertsson, Sten; Silfverstolpe, Johan; Rehn, Liselott; Nyman, T. L. M.; Lichtveld, Rob A.; Boomars, René; Bruins, Wendy; Ahlstedt, Björn; Puggioli, Helena; Lindgren, Erik; Smékal, David; Skoog, Gunnar; Kastberg, Robert; Lindblad, Anna; Halliwell, David; Box, Martyn; Arnwald, Fredrik K; Härdig, Bjarne Madsen; Chamberlain, Douglas; Herlitz, Johan; Karlsten, Rolf

doi:10.1186/1757-7241-21-5

Cited by 31 publications

(12 citation statements)

References 21 publications

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“…[129][130][131][132][133] The most likely explanation is that inexperienced rescuers underestimate the time required to apply the device, 134 which leads to a significant decrease in CCF during the first 5 minutes of an arrest [135][136][137] despite increases in CCF later in the resuscitation. 138 There is evidence that pre-event "pit crew" team training can reduce the pause required to apply the device.…”

Section: Additional Logistic Considerationsmentioning

confidence: 99%

Cardiopulmonary Resuscitation Quality: Improving Cardiac Resuscitation Outcomes Both Inside and Outside the Hospital

Meaney¹,

Bobrow²,

Mancini³

et al. 2013

Circulation

864

521

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The "2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" increased the focus on methods to ensure that high-quality cardiopulmonary resuscitation (CPR) is performed in all resuscitation attempts. There are 5 critical components of high-quality CPR: minimize interruptions in chest compressions, provide compressions of adequate rate and depth, avoid leaning between compressions, and avoid excessive ventilation. Although it is clear that high-quality CPR is the primary component in influencing survival from cardiac arrest, there is considerable variation in monitoring, implementation, and quality improvement. As such, CPR quality varies widely between systems and locations. Victims often do not receive high-quality CPR because of provider ambiguity in prioritization of resuscitative efforts during an arrest. This ambiguity also impedes the development of optimal systems of care to increase survival from cardiac arrest. This consensus statement addresses the following key areas of CPR quality for the trained rescuer: metrics of CPR performance; monitoring, feedback, and integration of the patient’s response to CPR; team-level logistics to ensure performance of high-quality CPR; and continuous quality improvement on provider, team, and systems levels. Clear definitions of metrics and methods to consistently deliver and improve the quality of CPR will narrow the gap between resuscitation science and the victims, both in and out of the hospital, and lay the foundation for further improvements in the future.

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Section: Additional Logistic Considerationsmentioning

confidence: 99%

Cardiopulmonary Resuscitation Quality: Improving Cardiac Resuscitation Outcomes Both Inside and Outside the Hospital

Meaney¹,

Bobrow²,

Mancini³

et al. 2013

Circulation

864

521

View full text Add to dashboard Cite

show abstract

“…The LINC (LUCAS in Cardiac Arrest) study was designed to evaluate the effectiveness and safety of an algorithm using mechanical chest compressions combined with defibrillation during ongoing compressions (mechanical CPR) compared with manual CPR according to guidelines. 16,17 The rationale for this design of the algorithm with mechanical chest compressions was based on studies suggesting the importance of compressions before defibrillation and a minimal hands-off interval. 4,18,19 The primary objective was to assess whether treatment with mechanical CPR would result in superior 4-hour survival in patients with out-of-hospital cardiac arrest compared with treatment with manual CPR.…”

Section: -4mentioning

confidence: 99%

“…Its protocol has been described in detail. 17 For inclusion, patients had to be adults with unexpected out-of-hospital cardiac arrest for whom an attempt of resuscitation was considered appropriate. Exclusion criteria were traumatic cardiac arrest (including hanging), age younger than 18 years, known pregnancy, and a body size too large or small to fit the chest compression device.…”

Section: Study Design and Algorithmsmentioning

confidence: 99%

Mechanical Chest Compressions and Simultaneous Defibrillation vs Conventional Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest

Rubertsson

Lindgren

Smékal

et al. 2014

JAMA

Self Cite

375

223

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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 MEASURESFour-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.

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“…63 There are manual versions of this device, as well as electrically and pneumatically operated versions. 64 One trial has shown improved survival to discharge when active decompression from a manual device was combined with the impedance threshold device, the latter enhancing the negative intrathoracic pressure generated during chest decompression.…”

Section: Active Compression and Decompression Cprmentioning

confidence: 99%

Pulseless Electric Activity

et al. 2013

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The Study Protocol for the LINC (LUCAS in Cardiac Arrest) Study: a study comparing conventional adult out-of-hospital cardiopulmonary resuscitation with a concept with mechanical chest compressions and simultaneous defibrillation

Cited by 31 publications

References 21 publications

Cardiopulmonary Resuscitation Quality: Improving Cardiac Resuscitation Outcomes Both Inside and Outside the Hospital

Cardiopulmonary Resuscitation Quality: Improving Cardiac Resuscitation Outcomes Both Inside and Outside the Hospital

Mechanical Chest Compressions and Simultaneous Defibrillation vs Conventional Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest

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