Table 1 Summary of randomized controlled trials comparing routine use of mechanical CPR with manual CPR in OHCA
| Load-distributing band trials | Piston-device trials | ||||
|---|---|---|---|---|---|
| Hallstrom et al. [20]a | CIRC [17] | Smekal et al. [21] | LINC [18] | PARAMEDIC [19] | |
| Design | Efficacy superiortity multicentre RCT | Efficacy equivalence multicentre RCT | Pilot multicentre RCT | Efficacy superiority multicentre RCT | Effectiveness superiority multicentre RCT |
| Randomisation | Cluster- EMS station(s) (ratio 1:1) | Patient (ratio 1:1) | Patient (ratio 1:1) | Patient (ratio 1:1) | Cluster- ambulance (ratio 2 manual:1 mechanical) |
| Inclusion criteria | Adult non-traumatic OHCA | Adult OHCA of cardiac aetiology. EMS arrival time ≤ 16 min | Adult non-traumatic OHCA | Adult unexpected non-traumatic OHCA where resuscitation was appropriate | Adult non-traumatic OHCA where a trial vehicle was first ambulance on scene |
| Number of cases analysed | 1071 (1071 randomised) | 4231 (4753 randomised) | 149 | 2589 (2593 randomised) | 4470 (4471 randomised) |
| Setting | US/Canada | US /Europe | Sweden | Europe | UK |
| Sponsor | Industry | Industry | Academicb | Industry | Academic |
| Device used | Autopulse | Autopulse | LUCAS | LUCAS | LUCAS |
| Primary outcome |
4-h survival: Manual 29.5% vs mechanical 28.5%, p = 0.74 |
STD Manual 11.0% vs mechanical 9.4%, adj. OR 1.06 (95% CI 0.83, 1.37)c | Not specified |
4-h survival Manual 23.7% vs mechanical 23.6%, treatment difference − 0.05 (95% CI − 3.3, 3.2) |
30-day survival Manual 7% vs mechanical 6%, adj. OR 0.86 (95% CI 0.64, 1.15) |
| Key secondary outcomes |
Cardiac aetiology group (n = 767): STD: Manual 9.9% vs mechanical 5.8%, p = 0.06 (adjusted) Good neurological outcome: Manual 7.5% vs mechanical 3.1%, p = 0.006 |
Sustained ROSC: Manual 32.3% vs mechanical 28.6%, adj. OR 0.84 (95% CI 0.73, 0.96) Good neurological outcome in survivors: Manual 48.1% vs mechanical 44.4%, adj. OR 0.80 (95% CI 0.47, 1.37) |
ROSC: Manual 32% vs mechanical 41%, p = 0.30 STD: Manual 10% vs mechanical 8%, p = 0.78 |
STD: Manual 9.2% vs mechanical 9.0%, treatment difference − 0.15 (95% CI − 2.4, 2.1) Good neurological outcome: Manual 7.3% vs mechanical 8.1%, treatment difference 0.78 (95% CI − 1.3, 2.8) |
ROSC: Manual 31% vs mechanical 32%, adj. OR 0.99 (95% CI 0.86, 1.14) Good neurological outcome: Manual 6% vs mechanical 5%, adj. OR 0.72 (95% CI 0.52, 0.99) |