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The Ontario Trial of Active Compression-Decompression Cardiopulmonary Resuscitation for In-Hospital and Prehospital Cardiac Arrest
Ian G. Stiell, MD, MSc, FRCPC;
Paul C. Hébert, MD, MHSc, FRCPC;
George A. Wells, PhD;
Andreas Laupacis, MD, MSc, FRCPC;
Katherine Vandemheen, BScN;
Jonathan F. Dreyer, MD, FRCPC;
Mary A. Eisenhauer, MD, FRCPC;
John Gibson, MD, FRCPC;
Lyall A. J. Higginson, MD, FRCPC;
Ann S. Kirby, MD, FRCPC;
Jeffrey L. Mahon, MD, FRCPC;
Justin P. Maloney, MD, FRCPC;
Brian N. Weitzman, MD, FRCPC
JAMA. 1996;275(18):1417-1423.
Abstract
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Objective.
—To compare the impact of active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) and standard CPR on the outcomes of in-hospital and prehospital victims of cardiac arrest.
Design.
—Randomized controlled trial with blinding of allocation using a sealed container.
Settings.
—(1) Emergency departments, wards, and intensive care units of 5 university hospitals and (2) all locations outside hospitals in 2 midsized cities.
Patients.
—A total of 1784 adults who had cardiac arrest.
Intervention.
—Patients received either standard or ACD CPR throughout resuscitation.
Main Outcome Measures.
—Survival for 1 hour and to hospital discharge and the modified Mini—Mental State Examination (MMSE).
Results.
—All characteristics were similar in the standard and ACD CPR groups for the 773 in-hospital patients and the 1011 prehospital patients. For in-hospital patients, there were no significant differences between the standard (n=368) and ACD (n=405) CPR groups in survival for 1 hour (35.1% vs 34.6%; P=.89), in survival until hospital discharge (11.4% vs 10.4%; P=.64), or in the median MMSE score of survivors (37 in both groups). For patients who collapsed outside the hospital, there were also no significant differences between the standard (n=510) and ACD (n=501) CPR groups in survival for 1 hour (16.5% vs 18.2%; P=.48), in survival to hospital discharge (3.7% vs 4.6%; P=.49), or in the median MMSE score of survivors (35 in both groups). Exploration of clinically important subgroups failed to identify any patients who appeared to benefit from ACD CPR.
Conclusions.
—ACD CPR did not improve survival or neurologic outcomes in any group of patients with cardiac arrest.
(JAMA. 1996;275:1417-1423)
Author Affiliations
From the Division of Emergency Medicine (Drs Stiell, Maloney, and Weitzman), Department of Medicine (Drs Hébert, Wells, Laupacis, and Higginson), and Clinical Epidemiology Unit (Ms Vandemheen), University of Ottawa (Ontario); and Division of Emergency Medicine (Drs Dreyer, Eisenhauer, and Gibson) and Department of Medicine (Drs Kirby and Mahon), University of Western Ontario, London.
Footnotes
Reprints: Ian G. Stiell, MD, MSc, FRCPC, Clinical Epidemiology Unit, Loeb Medical Research Institute, Ottawa Civic Hospital, 1053 Carling Ave, Ottawa, Ontario, Canada K1Y 4E9.
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