Active compression-decompression cardiopulmonary resuscitation does not improve survival in patients with prehospital cardiac arrest in a physician-manned emergency medical system

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 10; no. 2; pp. 178 - 186
• Main Authors: Luiz, Thomas, Ellinger, Klaus, Denz, Christof
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01-02-1996; Elsevier
• Subjects: active compression-decompression; Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiopulmonary Resuscitation; closed chest compression; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Female; Heart Arrest - mortality; Heart Arrest - therapy; Humans; Intensive care medicine; Male; Medical sciences; Middle Aged; prehospital cardiac arrest; cardiopulmonary resuscitation; closed chest compression; prehospital cardiac arrest; active compression-decompression; Human; Intensive cardiocirculatory care; Cardiocirculatory arrest; Treatment; Cardiocirculatory support; External; Cardiovascular disease; Survival; Cardiac massage
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1016/S1053-0770(96)80234-5

To examine the efficacy of a new method of cardiac resuscitation, active compression-decompression cardiopulmonary resuscitation (ACD CPR), in prehospital cardiac arrest.
Prospective, randomized, controlled trial.
Physician-manned Mobile Intensive Care Unit (MICU) of a university hospital, serving a population of 200,000.
Adult patients with prehospital nontraumatic cardiac arrest treated by the MICU.
Patients were randomized to standard chest compression according to American Heart Association (AHA) recommendations (group 1, 30 patients) or to the new technique (group 2, 26 patients). ACD was performed by use of a hand-held suction device. In both groups, advanced life support was performed as recommended by the AHA.
Rate of patients regaining a spontaneous circulation (ROSC), hospital discharge rate, and mean carbon dioxide content during resuscitation were recorded. ROSC rates in groups 1 and 2 were 40% and 38.5%, respectively. Four patients (13.3%) in group 1 and three patients (11.5%) in group 2 were discharged (group 1
v group 2: n.s.). Anatomic conditions precluded the application of ACD CPR in 5 patients. The new technique was found to impose greater physical efforts than STD CPR. Capnography was performed in 23 patients (mean value: STD CPR: 11.9 ± 4.7 mmHg, ACD CPR: 13.7 ± 4.9 mmHg [n.s.]).
ACD CPR did not improve, outcome and practical performance was complicated. Therefore, this technique should not be performed routinely, or without strict supervision in prehospital cardiac arrest.