Introduction An original research titled “Ismechanical-assist device better than manual chest compression? A randomizedcontrolled trial” published by Dove Medical Press Limited showed theresults of a randomized controlled trial (RCT) on whether a mechanical-assistdevice, the CPR RsQ Assist Device (CPR RAD) is better than manual chestcompression (Yuksen et al., 2017). Thisessay would critique and appraise the research evidence by means of the Joanna Briggs Institute 2017 CriticalAppraisal Checklist for RCT (“checklist”). Study Design and Conduct An impact evaluation basedon experimental design was performed and participants were chosen at randomfrom the eligible population – individuals who are likely to perform CPR suchas medical students, physicians, nurses, emergency medicine technicians and hospitalstaff (White et al., 2014). Todetermine how the CPR RAD affects the CPR in terms of chest compression qualityin a manikin model, 80 participants were randomly separated into 2 groups – Theexperimental (treatment) group of 41 participants using the device and acontrol group of 39 participants doing the manual compression using thesix-block randomization.
All participants had to perform a maximum of 4 minutesof hands-only compression with or without a device. This shows that theresearch used both random sampling and true random assignment, an essentialcharacteristic of RCT as suggested by White etal. (2014), thus satisfying the first checklist. The randomization methodused sequentially numbered, opaque, sealed envelopes (SNOSE), the standardmethod of ensuring allocation concealment and central randomization from whichthe centralized assignment protocol does not involve any person associated withthe research trial (Baghbaninaghadehi et al., 2016).
Thisdemonstrates that besides having a randomization process in place, Baghbaninaghadehi etal. (2016) suggested that a proper allocation procedure was alsodone to reduce biases and increase the study’s power, henceforth satiatingthe second checklist. Besides choosing an appropriate sample of thepopulation to measure the relevant baseline variables, the researchers also adoptedtests of significance that utilize P-valuein determining the statistical significance of the observed baseline differencein the participants’ characteristics (Egbewale, 2015).
This research shows that there wereno statistically significant differences between the groups in terms of age, sex,CPR experience, and percentage of participants who had completed a CPR coursei.e. P-values of more than 0.05. Thisimplied that the clinical characteristics of the participants in both groupsare similar at the baseline, which fulfils the third checklist.
The participants were notblinded to the trial allocation after the random allocation as they were veryaware of the need to perform chest compression on the Resusci Anne®SkillReporter™ for a maximum of 4 minutes or until fatigued. The manual groupperformed standard chest compression, while the device group performed chestcompression using the CPR RAD with a set rate of 100 times/minute. “Blinding”in randomized trials refers both to the general methodological principle ofwithholding information from individuals with the aim of preventing bias and toa group of procedures used to withhold information from specific groups ofindividuals such as patients, treatment providers, or outcome assessors (Hróbjartsson, 2011). Hence, itwas not applicable to achieve the fourth, fifth and sixth checklist. White et al.
(2014) suggested that it is important to check that participantsin the control groups do not suffer from “contamination” through a similarintervention being carried out in the control areas. The research did notindicate if there were other exposures or treatments occurring at the same timewith the “cause” that could explain the “effect”. Therefore, it is unclear ifit fulfils the 7th checklist. The attrition for allrandomly allocated participants remained the same from the initialrandomization process to the end time of the trial i.e.
no dropout rates. Thismeant that was no loss to follow up between the 2 groups which could severelycompromise the study’s validity (Dettori, 2011). There is also complete knowledgein terms of measurements. This shows that the follow up was complete, thus the8th checklist was fulfilled. All RCT results should be analyzed on anintention-to-treat (ITT) basis to reduce potential biases. It is a strategy inthe conduct and analysis of RCTs which ensures that all patients allocated to bothgroups are analyzed together in the respective groups to which they wererandomized, whether or not they completed the study (Gupta, 2015).
There was noindication in the research paper that the ITT analysis was conducted. For thatreason, it did not justify the 9th checklist. The results of the studyshowed the chest compression results – chest compression rates and depth – betweenthe manual chest compression group and chest compression with automatic chestcompression device group in a table form. However, it did not specify how the resultswere achieved – Is it measured by the same displacement sensor on the manikin? Was the same accelerometerused by all participants? (Gauna, 2016) Was the measurement procedures thesame for all participants? Therefore, it is not distinct if the outcomes were measured in the same way for bothgroups. With that, it is not clear if it satisfies the 10thchecklist. It is not clear if the studysatisfies the 11th checklist.
The reliability of the measurement wasunclear as the study did not specify the number of raters, training of raters,the intra-rater reliability, and the inter-raters reliability within the study.It is important to specify these details in such study as a variation betweenraters may jeopardize the integrity of the inquiries, and could potentiallyhave an impact on the results (Gwet, 2016). Statistical Analysis and Reporting In its statistical analysis,the characteristics of all participants in each group as well as the chestcompression results for both groups were compared by using descriptivestatistics. The STATA software version 14 (StataCorp LP, College Station, TX,USA) was used to perform the analyses. By adopting descriptive statistics, the datawere summarized in table form the datawith the purpose of describing the characteristics of the participants and thecompression results.
It enabled detection of sample characteristics that mayinfluence the conclusions (Thompson). This concludes that an appropriatestatistical analysis, which satisfies the 12th checklist. The research adopted a standardparallel design which divides the sample population into 2 groups (Spieth et al.
, 2016) – the experimental(treatment) group of 41 participants use the device whilst a control group of39 participants use manual compression (White et al., 2014). This design is appropriate for such study, thusfulfilling the 13th checklist. Conclusion TheRCT was relatively reliable and appropriate to justify the authors’ conclusionthat the CPR RAD is more effective in chest compression in comparison with the manualchest compression as using the device led to better outcomes in terms offatigue reduction and proper compression rate. It clearly described the planning,conduct, and analysis of the study. The chest compression results between themanual chest compression group and the device group were well described andanalyzed by the P-value as depictedin Table 2.
The study results and their interpretation were discussed in detailand the limitations of the methods used were also described. However, the resultsstill did not justify the use of the device wholly for chest compressions inclinical situations and should be critically evaluated further before itsrelevance can be considered