Prehospital randomised assessment of a mechanical compression device in out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised trial and economic evaluation

Background: Mechanical chest compression devices may help to maintain high-quality cardiopulmonary resuscitation (CPR), but little evidence exists for their effectiveness. We evaluated whether or not the introduction of Lund University Cardiopulmonary Assistance System-2 (LUCAS-2; Jolife AB, Lund, Sweden) mechanical CPR into front-line emergency response vehicles would improve survival from out-of-hospital cardiac arrest (OHCA). Objective: Evaluation of the LUCAS-2 device as a routine ambulance service treatment for OHCA. Design: Pragmatic, cluster randomised trial including adults with non-traumatic OHCA. Ambulance dispatch staff and those collecting the primary outcome were blind to treatment allocation. Blinding of the ambulance These results were obtained both in the within-trial analysis and in the analysis that modelled lifetime costs and outcomes. When missing data were handled by multiple imputation, estimated costs were higher in both arms, but the incremental cost-effectiveness ratios also indicated that manual CPR dominates LUCAS-2. Conclusions The trial, systematic review and economic evaluation all found that there was no evidence that mechanical chest compression using LUCAS-2 was superior to standard manual chest compression.