Post-admission outcomes of participants in the PARAMEDIC trial: A cluster randomised trial of mechanical or manual chest compressions

BACKGROUND

The PARAMEDIC cluster randomised trial evaluated the LUCAS mechanical chest compression device, and did not find evidence that use of mechanical chest compression led to an improvement in survival at 30 days. This paper reports patient outcomes from admission to hospital to 12 months after randomisation.

METHODS

Information about hospital length of stay and intensive care management was obtained through linkage with Hospital Episode Statistics and the Intensive Care National Audit and Research Centre. Patients surviving to hospital discharge were approached to complete questionnaires (SF-12v2, EQ-5D, MMSE, HADS and PTSD-CL) at 90days and 12 months. The study is registered with Current Controlled Trials, number ISRCTN08233942.

RESULTS

377 patients in the LUCAS arm and 658 patients in the manual chest compression were admitted to hospital. Hospital and intensive care length of stay were similar. Long term follow-up assessments were limited by poor response rates (53.7% at 3 months and 55.6% at 12 months). Follow-up rates were lower in those with worse neurological function. Among respondents, long term health related quality of life outcomes and emotional well-being was similar between groups. Cognitive function, measured by MMSE, was marginally lower in the LUCAS arm mean 26.9 (SD 3.7) compared to control mean 28.0 (SD 2.3), adjusted mean difference -1.5 (95% CI -2.6 to -0.4).

CONCLUSION

There were no clinically important differences identified in outcomes at long term follow-up between those allocated to the mechanical chest compression compared to those receiving manual chest compression.

Changes in throwing by older adults: a longitudinal investigation

This investigation examined change in a motor pattern requiring multisegmented coordination in older adults. The overarm throw was observed longitudinally in 8 elderly individuals over 7 years. Data were evaluated using Roberton's (Roberton & Halverson, 1984) movement components. Contrasting the assumed pattern of aging, only small declines in movement form were observed. Individual cases revealed additional, noncategorizable declines within component categories, including slower movement speed and decreased range of motion. Increased trial-to-trial variability also was associated with change. These changes suggested that elderly participants coordinated their movements in a manner similar to younger participants but controlled them differently. The small changes observed in this investigation suggest that performance, at least for some skills, is more stable than traditionally assumed.

Proactive downsizing: merging two units into one

Downsizing is a word firmly entrenched in the vocabulary of healthcare institutions. So, nurse managers, will your area be downsized by choice or by mandate? Will you be proactive or reactive? The decision is up to you. Two surgical nurse managers recognized the signs of the times and developed their own downsizing proposal to merge two units. Here are the steps they followed for a proactive approach to combine two clinical units into one.

Throwing patterns of older adults: a follow-up investigation

Previous investigations of the movement patterns of older adults have focused on functional movements. Performance declines have been reported with increasing age. Many investigations, however, do not require older adults to perform maximal, force producing actions. Smaller declines might be observed if older adults made a maximal effort. This investigation examined changes in a maximal skill--the overarm throw for force. Active, older adults were videotaped as they threw tennis balls. Thirteen people were filmed for two consecutive years. Gender and age differences were examined for movement patterns, ball velocity, and selected kinematic measures. Participants threw using patterns and velocities generally observed in children in middle elementary-school years. This result suggested there was a decline in this force production skill. Some older adults regressed in the movement patterns they used over the two years of testing. Older males threw faster, using more advanced movement patterns than older females.

Young children's Rod-and-Frame Test performance

Research on children's performance on the Witkin Rod-and-frame Test has suggested that children rely heavily on contextual cues in perceiving verticality but that this reliance decreases with age. In the present study this developmental trend in children younger than those previously tested was studied. The effect on performance of the conventional practice of tilting subjects in a chair which rotates about a seat axis, thus displacing the head away from the stimulus, was also studied. After a short training session 14 boys and 11 girls, 4.70 to 10.95 yr. old, were given 12 trials of the standard test while tilted about a seat axis and, on another day, 12 trials while tilted about a head axis. Although the axis of tilt and the order of presentation were nonsignificant, data tended to confirm the existence of a developmental trend in young children. An alternate scoring procedure to investigate errors in the direction opposite frame-tilt indicated that the initial tilt of the rod relative to the frame significantly affects the accuracy of judgments of the vertical.