• Myocardial Infarction
• Cardiology Clinical Trials

• Cardiology & Cardiovascular Medicine
• Myocardial Infarction
• Cardiology Clinical Trials

Effective manual cardiopulmonary resuscitation (CPR) can be difficult to perform. After 2 to 3 minutes of attempting to compress the chest 100 times each minute, only ∼20% to 30% of the compressions may achieve the needed depth of 5 to 6 cm. In addition, interruptions in chest compressions (eg, to analyze heart rhythm) are detrimental to re-initiating circulation. The LUCAS system is a piston-driven device with a suction cup (for adequate chest recoil) designed to deliver compressions according to resuscitation guidelines (100 compressions/ minute) at a depth of 4 to 5 cm. In contrast to manual CPR (M-CPR), defibrillation can be delivered during LUCAS CPR (L-CPR), to minimize interruptions to compressions.

A Comparison of Conventional Adult Out-of-Hospital Cardiopulmonary Resuscitation Against a Concept With Mechanical Chest Compressions and Simultaneous Defibrillation study [LINC; NCT00609778] presented by Sten Rubertsson, MD, Uppsala University, Uppsala, Sweden, sought to examine the efficacy and safety of the LUCAS device in contrast with M-CPR.

The prospective, multicenter, randomized, controlled LINC study screened ∼5000 patients from six European sites who had suffered an out-of-hospital cardiac arrest and needed resuscitation; 2593 were ultimately randomized. Of these, 1300 were randomized to L-CPR and 1289 to M-CPR. Patients in the L-CPR arm received M-CPR until the device could be applied. Baseline characteristics between the L-CPR and M-CPR groups were similar.

The primary endpoint was survival (defined as return of spontaneous circulation [ROSC]) at 4 hours after CPR. The secondary endpoint was survival up to 6 months with a good neurological outcome (defined as cerebral performance category [CPC] 1 or 2). The inclusion criterion was unexpected adult out-of-hospital cardiac arrest where an attempt of resuscitation was considered appropriate. Exclusion criteria were traumatic cardiac arrest, including hanging; age <18 years; known pregnancy; and patient body size not fitting the LUCAS. Those patients who were defibrillated prior to the arrival of LUCAS or those with ventricular fibrillation/ventricular tachycardia that were defibrillated leading to ROSC were also excluded. Prof. Rubertsson noted that these last criteria may have excluded patients most likely to survive for at least 4 hours. Approximately 50% of subjects had asystole and 20% had pulseless electrical activity at randomization in each arm.

There was no difference in the primary outcome of survival at 4 hours (23.6% with L-CPR vs 23.7% with M-CPR; 95% CI, −3.32 to 3.23; p=1.00). The secondary outcomes were similar between groups.

Poor neurologic outcomes, CPC 3 or 4 (excluding those with brain death [CPC 5]) were infrequent in both groups. Rates of poor neurologic outcomes were low after hospital discharge and similar between groups.

The overall results indicate that LUCAS-aided CPR is not superior to manual CPR for 4 hours post CPR survival. Prof. Rubertsson noted that this was a somewhat surprising outcome given the difficulty of M-CPR. Further analyses by initial rhythm, time to CPR, and by whether the arrest was witnessed by the emergency medical services team will be important.

• © 2013 MD Conference Express®