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Outcome among VF/VT patients in the LINC (LUCAS IN cardiac arrest) trial—A randomised, controlled trial

Hardig, Bjarne Madsen LU orcid ; Lindgren, Erik ; Östlund, Ollie ; Herlitz, Johan ; Karlsten, Rolf and Rubertsson, Sten (2017) In Resuscitation 115. p.155-162
Abstract

Introduction The LINC trial evaluated two ALS-CPR algorithms for OHCA patients, consisting of 3 min’ mechanical chest compression (LUCAS) cycles with defibrillation attempt through compressions vs. 2 min’ manual compressions with compression pause for defibrillation. The PARAMEDIC trial, using 2 min’ algorithm found worse outcome for patients with initial VF/VT in the LUCAS group and they received more adrenalin compared to the manual group. We wanted to evaluate if these algorithms had any outcome effect for patients still in VF/VT after the initial defibrillation and how adrenalin timing impacted it. Method Both groups received manual chest compressions first. Based on non-electronic CPR process documentation, outcome, neurologic... (More)

Introduction The LINC trial evaluated two ALS-CPR algorithms for OHCA patients, consisting of 3 min’ mechanical chest compression (LUCAS) cycles with defibrillation attempt through compressions vs. 2 min’ manual compressions with compression pause for defibrillation. The PARAMEDIC trial, using 2 min’ algorithm found worse outcome for patients with initial VF/VT in the LUCAS group and they received more adrenalin compared to the manual group. We wanted to evaluate if these algorithms had any outcome effect for patients still in VF/VT after the initial defibrillation and how adrenalin timing impacted it. Method Both groups received manual chest compressions first. Based on non-electronic CPR process documentation, outcome, neurologic status and its relation to CPR duration prior to the first detected return of spontaneous circulation (ROSC), time to defibrillation and adrenalin given were analysed in the subgroup of VF/VT patients. Results Seven hundred and fifty-seven patients had still VF/VT after initial chest compressions combined with a defibrillation attempt (374 received mechanical CPR) or not (383 received manual CPR). No differences were found for ROSC (mechanical CPR 58.3% vs. manual CPR 58.6%, p = 0.94), or 6-month survival with good neurologic outcome (mechanical CPR 25.1% vs. manual CPR 23.0%, p = 0.50). A significant difference was found regarding the time from start of manual chest compression to the first defibrillation (mechanical CPR: 4 (2–5) min vs manual CPR 3 (2–4) min, P < 0.001). The time from the start of manual chest compressions to ROSC was longer in the mechanical CPR group. Conclusions No difference in short- or long-term outcomes was found between the 2 algorithms for patients still in VF/VT after the initial defibrillation. The time to the 1st defibrillation and the interval between defibrillations were longer in the mechanical CPR group without impacting the overall outcome. The number of defibrillations required to achieve ROSC or adrenalin doses did not differ between the groups.

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author
; ; ; ; and
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Adrenaline, Cardiac arrest, Defibrillation, Mechanical chest compressions, Outcome, Ventricular fibrillation
in
Resuscitation
volume
115
pages
155 - 162
publisher
Elsevier
external identifiers
  • pmid:28385642
  • scopus:85018610447
ISSN
0300-9572
DOI
10.1016/j.resuscitation.2017.04.005
project
Helsingborg Resuscitation and Cardiovascular Research Group
language
English
LU publication?
no
id
e0acec1d-a7a0-473b-91e9-5ee9af1fa3ec
date added to LUP
2019-05-22 11:52:22
date last changed
2025-06-28 03:23:14
@article{e0acec1d-a7a0-473b-91e9-5ee9af1fa3ec,
  abstract     = {{<p>Introduction The LINC trial evaluated two ALS-CPR algorithms for OHCA patients, consisting of 3 min’ mechanical chest compression (LUCAS) cycles with defibrillation attempt through compressions vs. 2 min’ manual compressions with compression pause for defibrillation. The PARAMEDIC trial, using 2 min’ algorithm found worse outcome for patients with initial VF/VT in the LUCAS group and they received more adrenalin compared to the manual group. We wanted to evaluate if these algorithms had any outcome effect for patients still in VF/VT after the initial defibrillation and how adrenalin timing impacted it. Method Both groups received manual chest compressions first. Based on non-electronic CPR process documentation, outcome, neurologic status and its relation to CPR duration prior to the first detected return of spontaneous circulation (ROSC), time to defibrillation and adrenalin given were analysed in the subgroup of VF/VT patients. Results Seven hundred and fifty-seven patients had still VF/VT after initial chest compressions combined with a defibrillation attempt (374 received mechanical CPR) or not (383 received manual CPR). No differences were found for ROSC (mechanical CPR 58.3% vs. manual CPR 58.6%, p = 0.94), or 6-month survival with good neurologic outcome (mechanical CPR 25.1% vs. manual CPR 23.0%, p = 0.50). A significant difference was found regarding the time from start of manual chest compression to the first defibrillation (mechanical CPR: 4 (2–5) min vs manual CPR 3 (2–4) min, P &lt; 0.001). The time from the start of manual chest compressions to ROSC was longer in the mechanical CPR group. Conclusions No difference in short- or long-term outcomes was found between the 2 algorithms for patients still in VF/VT after the initial defibrillation. The time to the 1st defibrillation and the interval between defibrillations were longer in the mechanical CPR group without impacting the overall outcome. The number of defibrillations required to achieve ROSC or adrenalin doses did not differ between the groups.</p>}},
  author       = {{Hardig, Bjarne Madsen and Lindgren, Erik and Östlund, Ollie and Herlitz, Johan and Karlsten, Rolf and Rubertsson, Sten}},
  issn         = {{0300-9572}},
  keywords     = {{Adrenaline; Cardiac arrest; Defibrillation; Mechanical chest compressions; Outcome; Ventricular fibrillation}},
  language     = {{eng}},
  month        = {{06}},
  pages        = {{155--162}},
  publisher    = {{Elsevier}},
  series       = {{Resuscitation}},
  title        = {{Outcome among VF/VT patients in the LINC (LUCAS IN cardiac arrest) trial—A randomised, controlled trial}},
  url          = {{http://dx.doi.org/10.1016/j.resuscitation.2017.04.005}},
  doi          = {{10.1016/j.resuscitation.2017.04.005}},
  volume       = {{115}},
  year         = {{2017}},
}