This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Theresa M. Schwab, MD; Michael L. Callaham, MD; Christopher D. Madsen; Thomas A. Utecht, MD

JAMA. 1995;273(16):1261-1268.

Abstract
Objective.
—To compare the effectiveness of active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) with a handheld suction device vs standard manual CPR in victims of out-of-hospital cardiopulmonary arrest.

Design.
—Prospective randomized clinical trial with crossover group design.

Setting.
—Emergency medical services (EMS) of a large (San Francisco) and medium-sized (Fresno) city in California.

Patients.
—All normothermic adult victims of out-of-hospital, nontraumatic cardiac arrest on whom CPR was performed by first responders.

Intervention.
—Patients were randomized to receive either standard manual CPR according to American Heart Association guidelines or ACD CPR, on first-responder contact.

Main Outcome Measures.
—Return of spontaneous circulation, admission to the intensive care unit, survival to hospital discharge, and neurological function at hospital discharge.

Results.
—The ACD group (n=117 in Fresno; n=297 in San Francisco) and standard group (n=136 in Fresno; n=310 in San Francisco) were similar with regard to demographic and prognostic variables, such as age, witnessed arrest and bystander CPR frequency, and initial cardiac rhythm. Average interval from 911 call activation to EMS responder arrival was 6.4 minutes in Fresno and 4.0 minutes in San Francisco. In Fresno, there was no difference between the ACD group and standard CPR group in return of spontaneous circulation (17% vs 20%; P=.68), hospital admission (16% vs 20%; P=.56), hospital discharge (5% vs 7%; P=.64), or cerebral performance category score at discharge (1.5 vs 1.6; P=.90). Similarly, in San Francisco there was no difference between the ACD group and standard CPR group in return of spontaneous circulation (19% vs 21%; P=.65), hospital admission (13.5% vs 14.5%; P=.79), hospital discharge (4.7% vs 5.5%; P=.80), or cerebral performance category score at discharge (2.2 vs 2.6; P=.31). There was no increase in significant complications associated with the use of ACD CPR.

Conclusion.
—There was no improvement in outcome with ACD CPR in out-of-hospital cardiac arrest in these two cities. Differences in study design, demographics, EMS systems, response intervals, training, and technique performance may contribute to the lack of improvement in initial resuscitation with ACD CPR compared with previous studies. Future research needs to control these variables to determine the reason for these differences in outcome.

(JAMA. 1995;273:1261-1268)

Author Affiliations
From the University of California, San Francisco, San Joaquin Medical Education Program at Valley Medical Center, Fresno, Calif (Drs Schwab and Utecht), and Division of Emergency Medicine, University of California, San Francisco (Dr Callaham and Mr Madsen).

Footnotes
Reprint requests to Department of Emergency Medicine, University of California, San Francisco, San Joaquin Medical Education Program at Valley Medical Center, Fresno, CA 93702 (Dr Schwab).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Cardiopulmonary Resuscitation in Patients With Cancer
Varon and Marik
AM J HOSP PALLIAT CARE 2007;24:224-229.
ABSTRACT  

Acute management of sudden cardiac death in adults based upon the new CPR guidelines
Yannopoulos and Aufderheide
Europace 2007;9:2-9.
ABSTRACT | FULL TEXT  

Part 6: CPR Techniques and Devices
Circulation 2005;112:IV-47-IV-50.
FULL TEXT  

Reducing mortality from sudden cardiac death in the community: lessons from epidemiology and clinical applications research
Sotoodehnia et al.
Cardiovasc Res 2001;50:197-209.
ABSTRACT | FULL TEXT  

New Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care: Changes in the Management of Cardiac Arrest
Kern et al.
JAMA 2001;285:1267-1269.
FULL TEXT  

Emergency cardiac care: introduction
Ewy and Ornato
J Am Coll Cardiol 2000;35:825-880.
FULL TEXT  

Active Compression-Decompression Cardiopulmonary Resuscitation
Callaham et al.
NEJM 1999;341:1770-1772.
FULL TEXT  

CPR Techniques That Combine Chest and Abdominal Compression and Decompression : Hemodynamic Insights From a Spreadsheet Model
Babbs
Circulation 1999;100:2146-2152.
ABSTRACT | FULL TEXT  

A Comparison of Standard Cardiopulmonary Resuscitation and Active Compression-Decompression Resuscitation for Out-of-Hospital Cardiac Arrest
Plaisance et al.
NEJM 1999;341:569-575.
ABSTRACT | FULL TEXT  

The 1998 European Resuscitation Council guidelines for adult advanced life support
Advanced Life Support Working Group of the Europea
BMJ 1998;316:1863-1869.
FULL TEXT  

End-Tidal Carbon Dioxide and Outcome of Out-of-Hospital Cardiac Arrest
Levine et al.
NEJM 1997;337:301-306.
ABSTRACT | FULL TEXT  

Recommended Guidelines for Reviewing, Reporting, and Conducting Research on In-Hospital Resuscitation: The In-Hospital `Utstein Style' : A Statement for Healthcare Professionals From the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, the Australian Resuscitation Council, and the Resuscitation Councils of Southern Africa
Cummins et al.
Circulation 1997;95:2213-2239.
FULL TEXT  

Airway Management During Active Compression-Decompression CPR-Reply
Stiell et al.
JAMA 1996;276:449-449.
ABSTRACT  

The Ontario Trial of Active Compression-Decompression Cardiopulmonary Resuscitation for In-Hospital and Prehospital Cardiac Arrest
Stiell et al.
JAMA 1996;275:1417-1423.
ABSTRACT  

ACTIVE COMPRESSION-DECOMPRESSION CPR: IMPACT UNPROVEN
JWatch General 1995;1995:4-4.
FULL TEXT  

Plungers and Polemics: Active Compression-Decompression CPR and Federal Policy
Olson and Rennie
JAMA 1995;273:1299-1300.
ABSTRACT