title: Outcome among VF/VT patients in the LINC (LUCAS IN cardiac arrest) trial-A randomised, controlled trial.
abstract: The LINC trial evaluated two ALS-CPR algorithms for OHCA patients, consisting of 3min' mechanical chest compression (LUCAS) cycles with defibrillation attempt through compressions vs. 2min' manual compressions with compression pause for defibrillation. The PARAMEDIC trial, using 2min' 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Physio-Control, Lund, Sweden.
authors.forename: Bjarne Madsen
authors.initials: BM
authors.lastname: Hardig
authors.affiliation: Department of Surgical Sciences/Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala University Hospital, SE-751 85 Uppsala, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Lindgren
authors.affiliation: Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden.
authors.forename: Ollie
authors.initials: O
authors.lastname: Östlund
authors.affiliation: School of Health Sciences, Research Centre PreHospen, University of Borås, The Prehospital Research Centre of Western Sweden, Borås, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Herlitz
authors.affiliation: Department of Surgical Sciences/Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala University Hospital, SE-751 85 Uppsala, Sweden.
authors.forename: Rolf
authors.initials: R
authors.lastname: Karlsten
authors.affiliation: Department of Surgical Sciences/Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala University Hospital, SE-751 85 Uppsala, Sweden. Electronic address: sten.rubertsson@akademiska.se.
authors.forename: Sten
authors.initials: S
authors.lastname: Rubertsson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000401:mortality*; D004554:Electric Countershock / Q000379:methods / Q000706:statistics & numerical data; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D017180:Tachycardia, Ventricular / Q000150:complications; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000150:complications; D055815:Young Adult
chemical_list: D004837:Epinephrine
keywords: Adrenaline; Cardiac arrest; Defibrillation; Mechanical chest compressions; Outcome; Ventricular fibrillation