St. Emlyn´s - November 21, 2014 -By Simon Carley
"In some ways you might be forgiven for thinking that 2014 was a bit disappointing in terms of EBM. A number of clinical trials that I’ve been looking forward to for some time have in effect produced negative results. Early goal directed therapy, target blood pressures for sepsis, hypothermia for post cardiac arrest patients and the failure to find a mortality benefit for mechanical CPR in cardiac arrest patients.
Many of these trials share common themes in that they challenge current practice, established belief and in some cases strength of belief that borders on dogma.
This week we see the PARAMEDIC trial published in the Lancet. This is yet another trial that has produced a negative result and I urge you to read the paper, read this review, but also make sure that you get to the end as all is not what it may seem.
Mechanical CPR has been around for a very long time. Back when I was an SHO we briefly had experience with the ‘Thumper’ and a number of other mechanical devices designed to reduce the effort of CPR and to improve the quality of CPR. There is ample data that considerable effort is required to deliver effective CPR and that rescuers cannot maintain it for much more than a few minutes. There is therefore a great deal of face validity in transferring the effort of CPR over to a mechanical device...
What are the main findings?
Overall the research team found no difference in patient survival at 30 days, 3 months or 12 months. There was no statistically significant difference in the return of spontaneous circulation either. The only statistically significant difference was in terms of survival to favorable neurological outcome, after adjustment and then only just statistically significant."