Abstract
BackgroundMechanical chest compression devices deliver high-quality chest compressions. Early data suggests that mechanical devices may be superior to manual chest compressions in adults following an in-hospital cardiac arrest patients. To determine the feasibility of undertaking an effectiveness trial in this population, we undertook a feasibility randomised controlled trial. MethodsWe undertook a multi-centre parallel group feasibility randomised controlled trial (COMPRESS-RCT). Adult in-hospital cardiac arrest patients that were in a non-shockable rhythm were randomised in a 3:1 ratio to receive mechanical CPR (Jolfe AB/Stryker, Lund, Sweden) or ongoing manual CPR. Recruitment was led by the clinical cardiac arrest team.The primary study outcome was the proportion of eligible participants randomised in the study during site operational recruitment hours. Patients were enrolled under a model of deferred consent. We report data using descriptive statistics, point estimates and 95% confidence intervals. ResultsOver a two-year period, we recruited 127 patients across five UK hospitals. We recruited 55.2% (95% CI 48.5%–61.8%) of eligible study participants in site operational recruitment hours. Most participants were male (n = 76, 59.8%) with a mean age of 72 (95% CI: 69.9–74.9) years. Median arrest duration was 18 (IQR 13−29) minutes. In patients randomised to mech-CPR, median time from CPR start to device deployment was 11 (IQR 7−15) minutes. ROSC was achieved in 27.6% (n = 35) participants and 4.7% (n = 6) were alive at 30-days. ConclusionCOMPRESS-RCT identified important factors that preclude progression to an effectiveness trial of mechanical CPR in the hospital setting in the UK. Findings will inform the design of future in-hospital intra-arrest intervention trials.ISRCTN38139840, date of registration 9th January 2017.
Highlights
IntroductionData suggests that mechanical devices may be superior to manual chest compressions in adults following an in-hospital cardiac arrest patients
Mechanical chest compression devices deliver high-quality chest compressions
In out-of-hospital cardiac arrest, large randomised controlled trials show that mech-cardiopulmonary resuscitation (CPR) is not superior to manual CPR.7À9 As such, current guidelines recommend against the routine use of mech-CPR.[10]
Summary
Data suggests that mechanical devices may be superior to manual chest compressions in adults following an in-hospital cardiac arrest patients. Mechanical chest compression devices (mech-CPR) deliver highquality CPR.[6] In out-of-hospital cardiac arrest, large randomised controlled trials show that mech-CPR is not superior to manual CPR (man-CPR).7À9 As such, current guidelines recommend against the routine use of mech-CPR.[10] In contrast, research on mech-CPR use in the hospital setting has been limited. Small randomised controlled trials and observational studies have produced very low-certainty evidence that mech-CPR use in the hospital setting is associated with improved clinical outcomes.[11]
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