title: Manual vs. integrated automatic load-distributing band CPR with equal survival after out of hospital cardiac arrest. The randomized CIRC trial.
abstract: OBJECTIVE
  To compare integrated automated load distributing band CPR (iA-CPR) with high-quality manual CPR (M-CPR) to determine equivalence, superiority, or inferiority in survival to hospital discharge.
  
  
  METHODS
  Between March 5, 2009 and January 11, 2011 a randomized, unblinded, controlled group sequential trial of adult out-of-hospital cardiac arrests of presumed cardiac origin was conducted at three US and two European sites. After EMS providers initiated manual compressions patients were randomized to receive either iA-CPR or M-CPR. Patient follow-up was until all patients were discharged alive or died. The primary outcome, survival to hospital discharge, was analyzed adjusting for covariates, (age, witnessed arrest, initial cardiac rhythm, enrollment site) and interim analyses. CPR quality and protocol adherence were monitored (CPR fraction) electronically throughout the trial.
  
  
  RESULTS
  Of 4753 randomized patients, 522 (11.0%) met post enrollment exclusion criteria. Therefore, 2099 (49.6%) received iA-CPR and 2132 (50.4%) M-CPR. Sustained ROSC (emergency department admittance), 24h survival and hospital discharge (unknown for 12 cases) for iA-CPR compared to M-CPR were 600 (28.6%) vs. 689 (32.3%), 456 (21.8%) vs. 532 (25.0%), 196 (9.4%) vs. 233 (11.0%) patients, respectively. The adjusted odds ratio of survival to hospital discharge for iA-CPR compared to M-CPR, was 1.06 (95% CI 0.83-1.37), meeting the criteria for equivalence. The 20 min CPR fraction was 80.4% for iA-CPR and 80.2% for M-CPR.
  
  
  CONCLUSIONS
  Compared to high-quality M-CPR, iA-CPR resulted in statistically equivalent survival to hospital discharge.
authors.affiliation: Norwegian Center for Prehospital Emergency Care, Oslo University Hospital, Oslo, Norway. Electronic address: lars.wik@medisin.uio.no.
authors.forename: Lars
authors.initials: L
authors.lastname: Wik
authors.affiliation: Norwegian Center for Prehospital Emergency Care, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: Jan-Aage
authors.initials: JA
authors.lastname: Olsen
authors.affiliation: Houston Fire Department and the Baylor College of Medicine, Houston, TX, United States.
authors.forename: David
authors.initials: D
authors.lastname: Persse
authors.affiliation: Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: Fritz
authors.initials: F
authors.lastname: Sterz
authors.affiliation: Hillsborough County Fire Rescue, Tampa, FL, United States; Department of Emergency Medicine, Lake Erie College, Bradenton, FL, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Lozano
authors.affiliation: Heart Lung Center, Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Brouwer
authors.affiliation: Gold Cross Ambulance Service, Appleton Neenah-Menasha and Grand Chute Fire Departments, WI, United States; Theda Clark Regional Medical Center, Neenah, WI, United States.
authors.forename: Mark
authors.initials: M
authors.lastname: Westfall
authors.affiliation: Houston Fire Department and the Baylor College of Medicine, Houston, TX, United States.
authors.forename: Chris M
authors.initials: CM
authors.lastname: Souders
authors.affiliation: Wiener Rettung, Municipal ambulance service of Vienna, Vienna, Austria.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Malzer
authors.affiliation: Regional Ambulance Service Gelderland-Zuid, Nijmegen, The Netherlands.
authors.forename: Pierre M
authors.initials: PM
authors.lastname: van Grunsven
authors.affiliation: Hillsborough County Fire Rescue, Tampa, FL, United States.
authors.forename: David T
authors.initials: DT
authors.lastname: Travis
authors.affiliation: Medical and Pharmaceutical Statistics Research Unit, Department of Mathematics and Statistics, Fylde College, Lancaster University, Lancaster, United Kingdom.
authors.forename: Anne
authors.initials: A
authors.lastname: Whitehead
authors.affiliation: ZOLL Medical Corporation, Chelmsford, MA, United States.
authors.forename: Ulrich R
authors.initials: UR
authors.lastname: Herken
authors.affiliation: Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States.
authors.forename: E Brooke
authors.initials: EB
authors.lastname: Lerner
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate; D055815:Young Adult
keywords: Cardiac arrest; Cardiopulmonary resuscitation; Load distributing band; Survival