The Study Protocol for the LINC (LUCAS in Cardiac Arrest) Study: a study comparing conventional adult out-of-hospital cardiopulmonary resuscitation with a concept with mechanical chest compressions and simultaneous defibrillation

BACKGROUND: The LUCAS™ device delivers mechanical chest compressions that have been shown in experimental studies to improve perfusion pressures to the brain and heart as well as augmenting cerebral blood flow and end tidal CO(2,) compared with results from standard manual cardiopulmonary resuscitation (CPR). Two randomised pilot studies in out-of-hospital cardiac arrest patients have not shown improved outcome when compared with manual CPR. There remains evidence from small case series that the device can be potentially beneficial compared with manual chest compressions in specific situations. This multicentre study is designed to evaluate the efficacy and safety of mechanical chest compressions with the LUCAS™ device whilst allowing defibrillation during on-going CPR, and comparing the results with those of conventional resuscitation. METHODS/DESIGN: This article describes the design and protocol of the LINC-study which is a randomised controlled multicentre study of 2500 out-of-hospital cardiac arrest patients. The study has been registered at ClinicalTrials.gov (http://clinicaltrials.gov/ct2/show/NCT00609778?term=LINC&rank=1). RESULTS: Primary endpoint is four-hour survival after successful restoration of spontaneous circulation. The safety aspect is being evaluated by post mortem examinations in 300 patients that may reflect injuries from CPR. CONCLUSION: This large multicentre study will contribute to the evaluation of mechanical chest compression in CPR and specifically to the efficacy and safety of the LUCAS™ device when used in association with defibrillation during on-going CPR

The apparent effect of orbital drift on time series of MODIS MOD10A1 albedo on the Greenland ice sheet

The NASA MODIS MOD10A1 snow albedo product has enabled numerous glaciological applications. The temporal consistency of MODIS albedo is critical to obtaining reliable results from this 22-year time series. The orbit of Terra began to drift toward earlier acquisition times after the final inclination adjustment maneuver to maintain its nominal orbit by NASA on 27 February 2020, which may introduce biases that compromise the accuracy of quantitative time series analysis as the drift continues. Here, we evaluate the impact of Terra's orbital drift by comparing the differences between the Terra MODIS albedo and albedo products derived from Aqua MODIS, harmonized Landsat and Sentinel 2, Sentinel 3, and PROMICE (Programme for Monitoring of the Greenland Ice Sheet) ground measurements over the Greenland ice sheet. Our results suggest that the influence of orbital drift on albedo is small (+0.01 in 2020), but potentially biased for time series analysis. Our analysis also finds that the drift effect that causes earlier image acquisition time may lead to more apparently cloudy pixels and thus effectively reduce the Terra MODIS temporal resolution over Greenland

Algae drive enhanced darkening of bare ice on the Greenland ice sheet

Surface ablation of the Greenland ice sheet is amplified by surface darkening caused by light-absorbing impurities such as mineral dust, black carbon, and pigmented microbial cells. We present the first quantitative assessment of the microbial contribution to the ice sheet surface darkening, based on field measurements of surface reflectance and concentrations of light-absorbing impurities, including pigmented algae, during the 2014 melt season in the southwestern part of the ice sheet. The impact of algae on bare ice darkening in the study area was greater than that of non-algal impurities and yielded a net albedo reduction of 0.038 ± 0.0035 for each algal population doubling. We argue that algal growth is a crucial control of bare ice darkening, and incorporating the algal darkening effect will improve mass balance and sea level projections of the Greenland ice sheet and ice masses elsewhere

Impact of temporal data resolution on parameter inference and model identification in conceptual hydrological modeling: insights from an experimental catchment

This study presents quantitative and qualitative insights into the time scale dependencies of hydrological parameters, predictions and their uncertainties, and examines the impact of the time resolution of the calibration data on the identifiable system complexity. Data from an experimental basin (Weierbach, Luxembourg) is used to analyze four conceptual models of varying complexity, over time scales of 30 min to 3 days, using several combinations of numerical implementations and inference equations. Large spurious time scale trends arise in the parameter estimates when unreliable time-stepping approximations are employed and/or when the heteroscedasticity of the model residual errors is ignored. Conversely, the use of robust numerics and more adequate (albeit still clearly imperfect) likelihood functions markedly stabilizes and, in many cases, reduces the time scale dependencies and improves the identifiability of increasingly complex model structures. Parameters describing slow flow remained essentially constant over the range of subhourly to daily scales considered here, while parameters describing quick flow converged toward increasingly precise and stable estimates as the data resolution approached the characteristic time scale of these faster processes. These results are consistent with theoretical expectations based on numerical error analysis and dataaveraging considerations. Additional diagnostics confirmed the improved ability of the more complex models to reproduce distinct signatures in the observed data. More broadly, this study provides insights into the information content of hydrological data and, by advocating careful attention to robust numericostatistical analysis and stringent processoriented diagnostics, furthers the utilization of dense-resolution data and experimental insights to advance hypothesis-based hydrological modeling at the catchment scale.Dmitri Kavetski, Fabrizio Fenicia and Martyn P. Clar

Mechanical chest compressions improved aspects of CPR in the LINC trial

Aim: We studied resuscitation process metrics in patients with out-of-hospital cardiac arrest enrolled in a randomized trial comparing one protocol designed to best use a mechanical CPR device, with another based on the 2005 European Resuscitation Council guidelines for manual CPR. Methods: We analyzed clinical data, ECG signals, and transthoracic impedance signals for a subset of the patients in the LUCAS in Cardiac Arrest (LINC) trial, including 124 patients randomized to mechanical and 82 to manual CPR. Chest compression fraction (CCF) was defined as the fraction of time during cardiac arrest that chest compressions were administered. Results: Patients in the mechanical CPR group had a higher CCF than those in the manual CPR group [0.84 (0.78, 0.91) vs. 0.79 (0.70, 0.86), p &lt; 0.001]. The median duration of their pauses for defibrillation was also shorter [0 s (0, 6.0) vs. 10.0 s (7.0, 14.3), p &lt; 0.001]. Compressions were interrupted for a median of 36.0 s to apply the compression device. There was no difference between groups in duration of the longest pause in compressions [32.5 s vs. 26.0 s, p = 0.24], number of compressions received per minute [86.5 vs. 88.3, p = 0.47], defibrillation success rate [73.2% vs. 81.0%, p = 0.15], or refibrillation rate [74% vs. 77%, p = 0.79]. Conclusions: A protocol using mechanical chest compression devices reduced interruptions in chest compressions, and enabled defibrillation during ongoing compressions, without adversely affecting other resuscitation process metrics. Future emphasis on optimizing device deployment may be beneficial.</p

The apparent effect of orbital drift on time series of MODIS MOD10A1 albedo on the Greenland ice sheet

The NASA MODIS MOD10A1 snow albedo product has enabled numerous glaciological applications. The temporal consistency of MODIS albedo is critical to obtaining reliable results from this 22-year time series. The orbit of Terra began to drift toward earlier acquisition times after the final inclination adjustment maneuver to maintain its nominal orbit by NASA on 27 February 2020, which may introduce biases that compromise the accuracy of quantitative time series analysis as the drift continues. Here, we evaluate the impact of Terra's orbital drift by comparing the differences between the Terra MODIS albedo and albedo products derived from Aqua MODIS, harmonized Landsat and Sentinel 2, Sentinel 3, and PROMICE (Programme for Monitoring of the Greenland Ice Sheet) ground measurements over the Greenland ice sheet. Our results suggest that the influence of orbital drift on albedo is small (+0.01 in 2020), but potentially biased for time series analysis. Our analysis also finds that the drift effect that causes earlier image acquisition time may lead to more apparently cloudy pixels and thus effectively reduce the Terra MODIS temporal resolution over Greenland

Mechanical Chest Compressions and Simultaneous Defibrillation vs Conventional Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest

IMPORTANCE A strategy using mechanical chest compressions might improve the poor outcome in out-of-hospital cardiac arrest, but such a strategy has not been tested in large clinical trials. OBJECTIVE To determine whether administering mechanical chest compressions with defibrillation during ongoing compressions (mechanical CPR), compared with manual cardiopulmonary resuscitation (manual CPR), according to guidelines, would improve 4-hour survival. DESIGN, SETTING, AND PARTICIPANTS Multicenter randomized clinical trial of 2589 patients with out-of-hospital cardiac arrest conducted between January 2008 and February 2013 in 4 Swedish, 1 British, and 1 Dutch ambulance services and their referring hospitals. Duration of follow-up was 6 months. INTERVENTIONS Patients were randomized to receive either mechanical chest compressions (LUCAS Chest Compression System, Physio-Control/Jolife AB) combined with defibrillation during ongoing compressions (n = 1300) or to manual CPR according to guidelines (n = 1289). MAIN OUTCOMES AND MEASURES Four-hour survival, with secondary end points of survival up to 6 months with good neurological outcome using the Cerebral Performance Category (CPC) score. A CPC score of 1 or 2 was classified as a good outcome. RESULTS Four-hour survival was achieved in 307 patients (23.6%) with mechanical CPR and 305 (23.7%) with manual CPR (risk difference, -0.05%; 95% CI, -3.3% to 3.2%; P &gt; .99). Survival with a CPC score of 1 or 2 occurred in 98 (7.5%) vs 82 (6.4%) (risk difference, 1.18%; 95% CI, -0.78% to 3.1%) at intensive care unit discharge, in 108 (8.3%) vs 100 (7.8%) (risk difference, 0.55%; 95% CI, -1.5% to 2.6%) at hospital discharge, in 105 (8.1%) vs 94 (7.3%) (risk difference, 0.78%; 95% CI, -1.3% to 2.8%) at 1 month, and in 110 (8.5%) vs 98 (7.6%) (risk difference, 0.86%; 95% CI, -1.2% to 3.0%) at 6 months with mechanical CPR and manual CPR, respectively. Among patients surviving at 6 months, 99% in the mechanical CPR group and 94% in the manual CPR group had CPC scores of 1 or 2. CONCLUSIONS AND RELEVANCE Among adults with out-of-hospital cardiac arrest, there was no significant difference in 4-hour survival between patients treated with the mechanical CPR algorithm or those treated with guideline-adherent manual CPR. The vast majority of survivors in both groups had good neurological outcomes by 6 months. In clinical practice, mechanical CPR using the presented algorithm did not result in improved effectiveness compared with manual CPR.</p

Per-Protocol and Pre-Defined population analysis of the LINC study

OBJECTIVE: To perform two predefined sub-group analyses within the LINC study and evaluate if the results were supportive of the previous reported intention to treat (ITT) analysis.METHODS: Predefined subgroup analyses from the previously published LINC study were performed. The Per-Protocol population (PPP) included the randomized patients included in the ITT-population but excluding those with violated inclusion or exclusion criteria and those that did not get the actual treatment to which the patient was randomized. In the Pre-Defined population (PDP) analyses patients were also excluded if the dispatch time to ambulance arrival at the address exceeded 12min, there was a non-witnessed cardiac arrest, or if it was not possible to determine whether the arrest was witnessed or not, and those cases where LUCAS was not brought to the scene at the first instance.RESULTS: After exclusion from the 2589 patients within the ITT-population, the Per-Protocol analysis was performed in 2370 patients and the Pre-Defined analysis within 1133 patients. There was no significant difference in 4-h survival of patients between the mechanical-CPR group and the manual-CPR group in the Per-Protocol population; 279 of 1172 patients (23.8%) versus 281 of 1198 patients (23.5%) (risk difference -0.35%, 95% C.I. -3.1 to 3.8, p=0.85) or in the Pre-Defined population; 176 of 567 patients (31.0%) versus 192 of 566 patients (33.9%) (risk difference -2.88%, 95% C.I. -8.3 to 2.6, p=0.31). There was no difference in any of the second outcome variables analyzed in the Pre-Protocol or Pre-Defined populations.CONCLUSIONS: The results from these predefined sub-group analyses of the LINC study population did not show any difference in 4h survival or in secondary outcome variables between patients treated with mechanical-CPR or manual-CPR. This is consistent with the previously published ITT analysis.</p