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A New Method of Cardiopulmonary Resuscitation

Todd J. Cohen, MD; Kelly J. Tucker, MD; Keith G. Lurie, MD; Rita F. Redberg, MD; John P. Dutton; Kathy A. Dwyer, RN; Theresa M. Schwab; Michael C. Chin; Alan M. Gelb, MD; Melvin M. Scheinman, MD; Nelson B. Schiller, MD; Michael L. Callaham, MD; Cardiopulmonary Resuscitation Working Group

JAMA. 1992;267(21):2916-2923.

Abstract
Objective.
—To describe and compare with standard cardiopulmonary resuscitation (CPR) in humans a new form of CPR that involves both active compression and active decompression of the chest.

Design.
—Patients in cardiac arrest in whom standard advanced cardiac life support failed were randomized to receive 2 minutes of either standard or active compression-decompression (ACD) CPR using a custom, hand-held suction device, followed by 2 minutes of the alternate technique. The ACD device was applied midsternum and used to perform CPR according to the guidelines of the American Heart Association: 80 compressions per minute, compression depth of 3.8 to 5 cm, 50% duty cycle, and constant-volume ventilation. Mechanical Thumper CPR was also compared in five patients. End-tidal carbon dioxide (ETco2) concentrations and hemodynamic variables were measured. Transesophageal Doppler echocardiography was used to assess contractility, the velocity time integral (an analogue of cardiac output), and diastolic myocardial filling times.

Results.
—Ten patients were enrolled. The mean±SD ETco2 was 4.3±3.8 mm Hg with standard CPR and 9.0±3.9 mm Hg with ACD CPR (P<.0001). Systolic arterial pressure with standard CPR was 52.5±14.0 mm Hg and with ACD CPR, 88.9±24.7 mm Hg (P<.003). The velocity time integral increased from 7.3±2.6 cm with standard CPR to 17.5±5.6 cm with ACD CPR (P<.0001), and diastolic filling times increased from 0.23±09 seconds with standard CPR to 0.37±12 seconds with ACD CPR (P<.004). Mechanical Thumper CPR consistently underperformed both standard and ACD CPR. Minute ventilation obtained in four patients during ACD CPR without endotracheal ventilation was 6.6±0.9 L/min. After 1 hour of standard CPR failed, three of 10 patients randomized to ACD CPR rapidly converted to a hemodynamically stable rhythm following 2 minutes of ACD CPR.

Conclusion.
—ACD CPR is a simple manual technique that improved cardiopulmonary circulation in 10 patients during cardiac arrest. Although ACD CPR may have produced a return of spontaneous circulation in three patients refractory to standard measures, its impact on survival when used early in cardiac arrest remains to be determined.

(JAMA. 1992;267:2916-2923)

Author Affiliations
From the Department of Medicine and the Cardiovascular Research Institute (Drs Cohen, Tucker, Lurie, Redberg, Scheinman, and Schiller, Messrs Dutton and Chin, and Mss Dwyer and Schwab), and the Division of Emergency Medicine (Dr Callaham), University of California, San Francisco, and the Emergency Department, San Francisco General Hospital (Dr Gelb). Dr Cohen is now with the Cardiology Division, North Shore University Hospital—Cornell University Medical College, Manhasset, NY. A partial listing of the members of the Cardiopulmonary Resuscitation Working Group appears in the acknowledgments at the end of the article.

Footnotes
Presented at the 41st Annual Scientific Session of the American College of Cardiology, Dallas, Tex, April 13, 1992.

Reprint requests to Director of Electrophysiology, Cardiology Division, North Shore University Hospital— Cornell University Medical College, 300 Community Dr, Manhasset, NY 11030 (Dr Cohen).

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