Key result
A bundle of head-up CPR, mechanical compressions, and an ITD proves feasible during OHCA.
Why the study?
Out-of-hospital cardiac arrest outcomes remain poor, and the deliverability of a bundled approach incorporating multiple CPR adjuncts to improve cerebral perfusion and protection required evaluation.
Is a bundled intervention comprising head-up CPR, mechanical CPR, and an impedance threshold device feasible and deliverable compared to standard care in out-of-hospital cardiac arrest?
RCT (n=32)
1:1
Yes
Is a bundled intervention comprising head-up CPR, mechanical CPR, and an impedance threshold device feasible and deliverable compared to standard care in out-of-hospital cardiac arrest?
A novel CPR bundle comprising head-up positioning, mechanical compressions, and an impedance threshold device is feasible and safe to deliver during out-of-hospital cardiac arrest, supporting the design of a definitive outcomes trial.
Answers are grounded in this paper and cite their sources.
Demonstrates the prehospital feasibility and safety of this novel resuscitation bundle; leaves open whether.
• First randomised trial of a head-up CPR, mechanical CPR and ITD bundle. • On-scene randomisation during OHCA was feasible in prehospital care. • High protocol adherence achieved across ambulance and air ambulance services. • No safety concerns identified with delivery of the CPR bundle. • Findings inform the design of a definitive randomised outcomes trial. Out-of-hospital cardiac arrest (OHCA) outcomes remain poor. Improving cerebral perfusion during cardiopulmonary resuscitation (CPR) to achieve better neurological outcomes is therefore a key priority. A bundled approach incorporating multiple CPR adjuncts has been proposed to enhance cerebral protection during OHCA. CABARET was a multicentre randomised feasibility trial, designed to evaluate the deliverability of a novel resuscitation bundle during OHCA. Patients were randomised on scene in a 1:1 ratio to either usual care (advanced life support according to European Resuscitation Council 2021 guidelines) or a bundled intervention comprising: (1) head-up position CPR (HUP-CPR), (2) mechanical chest compressions using the LUCAS-3 device, and (3) an impedance threshold device (ITD). Primary feasibility outcomes included recruitment and randomisation rates, protocol adherence, training efficacy, and data collection completeness. All 32 of 32 planned patients were successfully recruited, representing 9.5% of potentially eligible OHCA cases. Three patients randomised to the intervention group did not receive the full bundle. Protocol adherence and training efficacy were high across participating sites. Data completeness was good overall, with the exception of peak end-tidal carbon dioxide measurements. The CABARET feasibility trial demonstrates that a head-up position and ITD CPR bundle can be delivered during OHCA with high fidelity and without impeding standard resuscitation care. Key insights regarding training, protocol compliance, and operational logistics provide a robust foundation for the design and conduct of a definitive randomised controlled trial.
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Plumb et al. (2026) conducted an RCT in Out-of-hospital cardiac arrest (OHCA) (n=32). Head-up position CPR, mechanical chest compressions (LUCAS-3), and impedance threshold device (ITD) bundle vs. Usual care (advanced life support) was evaluated on Recruitment and randomisation rates, protocol adherence, training efficacy, and data collection completeness. A bundle of head-up CPR, mechanical chest compressions, and an impedance threshold device was feasible during out-of-hospital cardiac arrest, successfully recruiting all 32 planned patients.
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