Comparison of standard cardiopulmonary resuscitation versus the combination of active compression-decompression cardiopulmonary resuscitation and an inspiratory impedance threshold device for out-of-hospital cardiac arrest

Active compression-decompression (ACD) CPR combined with an inspiratory impedance threshold device (ITD) improves vital organ blood flow during cardiac arrest. This study compared survival rates with ACD+ITD CPR versus standard manual CPR (S-CPR). A prospective, controlled trial was performed in Mai...

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Bibliographic Details
Published in:	Circulation (New York, N.Y.) Vol. 108; no. 18; pp. 2201 - 2205
Main Authors:	WOLCKE, Benno B, MAUER, Dietmar K, SCHOEFMANN, Mark F, TEICHMANN, Heinke, PROVO, Terry A, LINDNER, Karl H, DICK, Wolfgang F, AEPPLI, Dorothee, LURIE, Keith G
Format:	Journal Article
Language:	English
Published:	Hagerstown, MD Lippincott Williams & Wilkins 04-11-2003 American Heart Association, Inc
Subjects:	Adolescent Adult Aged Aged, 80 and over Biological and medical sciences Blood and lymphatic vessels Cardiology. Vascular system Cardiopulmonary Resuscitation - adverse effects Cardiopulmonary Resuscitation - methods Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Electric Countershock Emergency Medical Services - methods Emergency Medical Services - statistics & numerical data Female Germany Heart Arrest - therapy Humans Inhalation Male Medical sciences Middle Aged Prospective Studies Survival Rate Treatment Outcome Germany Intensive cardiocirculatory care cardiopulmonary resuscitation Treatment Active compression decompression Cardiovascular disease cardiac arrest Comparative study
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Summary:	Active compression-decompression (ACD) CPR combined with an inspiratory impedance threshold device (ITD) improves vital organ blood flow during cardiac arrest. This study compared survival rates with ACD+ITD CPR versus standard manual CPR (S-CPR). A prospective, controlled trial was performed in Mainz, Germany, in which a 2-tiered emergency response included early defibrillation. Patients with out-of-hospital arrest of presumed cardiac pathogenesis were sequentially randomized to ACD+ITD CPR or S-CPR by the advanced life support team after intubation. Rescuers learned which method of CPR to use at the start of each work shift. The primary end point was 1-hour survival after a witnessed arrest. With ACD+ITD CPR (n=103), return of spontaneous circulation and 1- and 24-hour survival rates were 55%, 51%, and 37% versus 37%, 32%, and 22% with S-CPR (n=107) (P=0.016, 0.006, and 0.033, respectively). One- and 24-hour survival rates in witnessed arrests were 55% and 41% with ACD+ITD CPR versus 33% and 23% in control subjects (P=0.011 and 0.019), respectively. One- and 24-hour survival rates in patients with a witnessed arrest in ventricular fibrillation were 68% and 58% after ACD+ITD CPR versus 27% and 23% after S-CPR (P=0.002 and 0.009), respectively. Patients randomized > or =10 minutes after the call for help to the ACD+ITD CPR had a 3 times higher 1-hour survival rate than control subjects (P=0.002). Hospital discharge rates were 18% after ACD+ITD CPR versus 13% in control subjects (P=0.41). In witnessed arrests, overall neurological function trended higher with ACD+ITD CPR versus control subjects (P=0.07). Compared with S-CPR, ACD+ITD CPR significantly improved short-term survival rates for patients with out-of-hospital cardiac arrest. Additional studies are needed to evaluate potential long-term benefits of ACD+ITD CPR.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 ObjectType-News-3 content type line 23
ISSN:	0009-7322 1524-4539
DOI:	10.1161/01.CIR.0000095787.99180.B5