A randomized clinical trial of active compression-decompression CPR vs standard CPR in out-of-hospital cardiac arrest in two cities
T. M. Schwab, M. L. Callaham, C. D. Madsen and T. A. Utecht
Department of Emergency Medicine, University of California, San Francisco, USA.
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.
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