The Ontario trial of active compression-decompression cardiopulmonary resuscitation for in-hospital and prehospital cardiac arrest
I. G. Stiell, P. C. Hebert, G. A. Wells, A. Laupacis, K. Vandemheen, J. F. Dreyer, M. A. Eisenhauer, J. Gibson, L. A. Higginson, A. S. Kirby, J. L. Mahon, J. P. Maloney and B. N. Weitzman
Division of Emergency Medicine, University of Ottawa, Ontario, Canada.
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.
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ABSTRACT
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Advanced Life Support Working Group of the Europea
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Similar Outcomes for Standard and ACD CPR
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