Evaluation of active compression-decompression CPR in victims of out-of-hospital cardiac arrest
K. G. Lurie, J. J. Shultz, M. L. Callaham, T. M. Schwab, T. Gisch, T. Rector, R. J. Frascone and L. Long
Department of Medicine, Medical School, University of Minnesota-Minneapolis.
OBJECTIVE--Active compression-decompression (ACD) cardiopulmonary
resuscitation (CPR) appears to improve ventilation and coronary perfusion
when compared with standard CPR. The objective was to evaluate potential
benefits of this new CPR technique in patients with out-of-hospital cardiac
arrest in St Paul, Minn. DESIGN--Ten-month, prospective, randomized
parallel-group design. SETTING--St Paul, Minn, population 270,000.
PATIENTS--All normothermic victims of nontraumatic cardiac arrest older
than 8 years who received CPR. MAIN OUTCOME MEASURES--Return of spontaneous
circulation, admission to the intensive care unit (ICU), return of baseline
neurological function (alert and oriented to person, place, and time),
survival to hospital discharge, survival to hospital discharge with return
of baseline neurological function, and complications.
RESULTS--Seventy-seven patients received standard CPR and 53 patients
received ACD CPR. The mean emergency medical services call response
interval was less than 3.5 minutes. When all patients were considered, a
higher percentage of ACD CPR patients had a return of spontaneous
circulation and were admitted to the ICU vs standard CPR (45% vs 31%, and
40% vs 26%, respectively), but these trends were not statistically
significant (P < .10 and P < .10). No statistically significant
differences were found between hospital discharge rates (12 [23%] of 53 for
ACD CPR vs 13 [17%] of 77 for standard CPR), return to baseline
neurological function (10 [19%] of 53 for ACD CPR vs 13 [17%] of 77 for
standard CPR), or return to baseline neurological function at hospital
discharge (nine [17%] of 53 for ACD CPR vs 12 [16%] of 77 for standard
CPR). Return of spontaneous circulation, ICU admission, and neurological
recovery in both CPR groups were highly correlated with downtime (time from
collapse to emergency medical system personnel arrival to the scene in
witnessed arrests). With less than 10 minutes' downtime, survival to the
ICU was 59% (19/32) with ACD CPR and 33% (16/49) with standard CPR (P <
.02), return to baseline neurological function was 31% (10/32) with ACD CPR
and 20% (10/49) with standard CPR (P = .27), and hospital discharge rate
was 38% (12/32) with ACD CPR and 20% (10/49) with standard CPR (P = .17).
Complication rates in patients admitted to the hospital were similar in
both groups. CONCLUSIONS--This study demonstrates that ACD CPR appears to
be more effective than standard CPR in a well-defined subset of victims of
out-of-hospital cardiac arrest during the critical early phases of
resuscitation. Based on this study, a larger study should be performed to
evaluate the potential long-term benefits of ACD CPR.
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