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Randomized Controlled Trial
. 2017 Jul;58(7):424-431.
doi: 10.11622/smedj.2017071.

Prompt use of mechanical cardiopulmonary resuscitation in out-of-hospital cardiac arrest: the MECCA study report

Venkataraman Anantharaman  1 , Boon Lui Benjamin Ng  2 , Shiang Hu Ang  3 , Chun Yue Francis Lee  4 , Siew Hon Benjamin Leong  5 , Marcus Eng Hock Ong  1   6 , Siang Jin Terrance Chua  7 , Antony Charles Rabind  8 , Nagaraj Baglody Anjali  1 , Ying Hao  9
Affiliations
Randomized Controlled Trial

Prompt use of mechanical cardiopulmonary resuscitation in out-of-hospital cardiac arrest: the MECCA study report

Venkataraman Anantharaman et al. Singapore Med J. 2017 Jul.

Abstract

Introduction: Early use of mechanical cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) may improve survival outcomes. Current evidence for such devices uses outcomes from an intention-to-treat (ITT) perspective. We aimed to determine whether early use of mechanical CPR using a LUCAS 2 device results in better outcomes.

Methods: A prospective, randomised, multicentre study was conducted over one year with LUCAS 2 devices in 14 ambulances and manual CPR in 32 ambulances to manage OHCA. The primary outcome was return of spontaneous circulation (ROSC). Secondary outcomes were survival at 24 hours, discharge from hospital and 30 days.

Results: Of the 1,274 patients recruited, 1,191 were eligible for analysis. 889 had manual CPR and 302 had LUCAS CPR. From an ITT perspective, outcomes for manual and LUCAS CPR were: ROSC 29.2% and 31.1% (odds ratio [OR] 1.09, 95% confidence interval [CI] 0.82-1.45; p = 0.537); 24-hour survival 11.2% and 13.2% (OR 1.20, 95% CI 0.81-1.78; p = 0.352); survival to discharge 3.6% and 4.3% (OR 1.20, 95% CI 0.62-2.33; p = 0.579); and 30-day survival 3.0% and 4.0% (OR 1.32, 95% CI 0.66-2.64; p = 0.430), respectively. By as-treated analysis, outcomes for manual, early LUCAS and late LUCAS CPR were: ROSC 28.0%, 36.9% and 24.5%; 24-hour survival 10.6%, 15.5% and 8.2%; survival to discharge 2.9%, 5.8% and 2.0%; and 30-day survival 2.4%, 5.8% and 0.0%, respectively. Adjusted OR for survival with early LUCAS vs. manual CPR was 1.47 after adjustment for other variables (p = 0.026).

Conclusion: This study showed a survival benefit with LUCAS CPR as compared to manual CPR only, when the device was applied early on-site.

Keywords: LUCAS; cardiac arrest; mechanical CPR; return of spontaneous circulation; survival to discharge.

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Figures

Fig. 1
Fig. 1
CONSORT diagram for the MECCA study. CPR: cardiopulmonary resuscitation; OHCA: out-of-hospital cardiac arrest; VT: ventricular tachycardia
Fig. 2
Fig. 2
Graph shows as-treated outcomes of manual cardiopulmonary resuscitation (CPR) (excluding ventricular tachycardia patients), and early- and late-LUCAS applications. The p-values in bold are significant. ROSC: return of spontaneous circulation
See this image and copyright information in PMC

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