MedicalResearch.com Interview with:
Prof Gavin D. Perkins MD
Clinical Professor in Critical Care Medicine Warwick Clinical Trials Unit Co-Director of Research;
Warwick Medical School and Heart of England NHS Foundation Trust
Medical Research: What is the background for this study?
Prof. Perkins: Each year around 30,000 people in the United Kingdom suffer out of hospital cardiac arrests and less than one in twelve of those returns home alive. Early high quality Cardio- Pulmonary Resuscitation (CPR – ventilation and chest compressions) is critical to survival. However maintaining high quality chest compressions during resuscitation is difficult for crews of emergency vehicles, especially if they are on their own, because of fatigue and the need to perform other actions. Chest compression is particularly difficult in moving vehicles.
A number of mechanical devices, suitable for out of hospital use, have been developed over the years to improve the quality of chest compressions and therefore attempt to improve patient outcomes. Some NHS organisations decided to purchase devices to use although there is limited evidence of their effectiveness. To equip all emergency vehicles in the NHS would cost tens of millions of pounds plus costs for on-going training and maintenance. This prompted the UK Joint Royal College Ambulance Liaison Committee to advise against the purchase of further mechanical chest compression devices until further research had been carried out.
The aim of this trial was to compare the effects of the mechanical chest compressions (LUCAS-2) device versus standard manual chest compressions (crew using their hands) on survival.
Medical Research: What are the main findings?
Prof. Perkins: The research team found that there was no difference in 30-day survival between the two types of chest compression; 6.3% of LUCAS-2 patients survived while 6.9% of manual CPR patients survived. Resuscitation by NHS paramedics delivering manual CPR was shown to be as effective as resuscitation utilising LUCAS-2 to deliver chest compressions. A number of important secondary findings were also reported. The results indicate that use of LUCAS-2 did not improve the percentage of patients:
· who had return of spontaneous circulation (ROSC) at any point (31.6% LUCAS-2 vs. 31.4% manual);
· who sustained ROSC to hospital (22.8% LUCAS-2 vs. 23.3% manual);
· with favourable neurologic outcome (4.7% LUCAS-2 vs. 6.0% manual).
The trial is the largest UK trial conducted in out of hospital cardiac arrest and the largest randomised trial undertaken of a mechanical chest compression device. The successful completion of the trial is testament to the great effort and support provided by all participating ambulance staff. It is a landmark trial in confirming the important role NHS Ambulance services play in conducting high quality research that is relevant to everyday NHS and international practice.
Medical Research: What should clinicians and patients take away from your report?
Prof. Perkins: The PaRAMeDiC trial confirms manual CPR by NHS Paramedics is as good as LUCAS-2 CPR and emphasises the importance of focusing on the provision of high quality chest compressions. Increasing bystander CPR, improving access to public access defibrillation and reducing ambulance response times to cardiac arrest victims remain the key to improving outcomes for cardiac arrest victims.
Medical Research: What recommendations do you have for future research as a result of this study?
The role of mechanical CPR during in-hospital cardiac arrest.
The role of mechanical CPR as part of a strategy to facilitate rescue percutaneous coronary intervention during cardiac arrest.
Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised controlled trial
Prof Gavin D Perkins MD,Ranjit Lall PhD,Prof Tom Quinn M Phil,Prof Charles D Deakin MD,Prof Matthew W Cooke PhD,Jessica Horton MSc,Prof Sarah E Lamb DPhil,Anne-Marie Slowther DPhil,Prof Malcolm Woollard MPH,Andy Carson FRCGP,Mike Smyth MSc,Richard Whitfield BSc,Amanda Williams MA,Helen Pocock MSc,John J M Black FCEM,John Wright FCEM,Kyee Han FCEM,Prof Simon Gates PhD,PARAMEDIC trial collaborators
The Lancet – 16 November 2014