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Table 1 Summary of randomized controlled trials comparing routine use of mechanical CPR with manual CPR in OHCA

From: Mechanical CPR: Who? When? How?

  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)
  1. aTrial stopped early by data monitoring board
  2. bOne author received consulting fee from device manufacturer
  3. cPrimary outcome result within pre-specified boundary of equivalence. Trial stopped early in accordance with pre-specified stopping rule
  4. EMS Emerency Medical Service, OHCA out-of-hospital cardiac arrest, RCT randomised controlled trial, STD survival to discharge, adj OR adjusted odds ratio