A few weeks ago we reported on the use of the LUCAS-2 for crushing the thorax, resulting in significant internal injuries. None of these injuries were judged to have contributed to any patient’s demise – but, still, concerning. This could be more forgivable if there were other advantages, say, survival.
Unfortunately, yet again, mechanical CPR fails to demonstrate superiority.
This is the PARAMEDIC trial, from the Lancet, a cluster-randomized trial aiming to demonstrate the superiority of the LUCAS-2 device as compared to manual CPR. Based on a deployment of 143 available LUCAS devices, these authors compared 1,652 patients randomized to attempt device deployment compared with 2,819 in a control group. There were no important differences in the baseline characteristics of the two groups, and other measures of initial treatment were similar. And, in the end, there was no difference between initial return of circulation, event survival, 30-day survival, 3-month survival, or 12-month survival (all dismal).
The mildly interesting aspect to this trial is that it was not directly a test of the LUCAS device – but, rather, a pragmatic trial comparing deployment with LUCAS as an option with deployment without. Thus, 638 patients in the clusters randomized to include the LUCAS device received manual compressions. However, on multiple causal effect analyses, no advantage was detected from cases in which the LUCAS device was used, nor was a selection bias apparent.
In the absence of efficacy data, use of mechanical devices is defended primarily on the basis of convenience – freeing up hands for other tasks. However, this argument fails in the face of these data – as it does not appear the handsfree advantage, when available, results in improved patient outcomes.
“Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised controlled trial”
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61941-3/fulltext