Active compression-decompression cardiopulmonary resuscitation does not improve survival in patients with prehospital cardiac arrest in a physician- manned emergency medical system: J Cardiothorac Vasc Anesth 1996; 10/2; 178–186

Abstract

Object: To examine the efficacy of a new method of cardiac resuscitation, active compression-decompression cardiopulmonary resuscitation (ACD CPR), in prehospital cardiac arrest. Design: Prospective, randomized, controlled trial. Setting: Physician-manned Mobile Intensive Care Unit (MICU) of a university hospital, serving a population of 200,000. Participants: Adult patients with prehospital nontraumatic cardiac arrest treated by the MICU. Interventions: Patients were randomized to standard chest compression according to American Heart Association (AHA) recommendations (group 1, 30 patients) or to the new technique (group 2, 26 patients). ACD was performed by use of a hand-held suction device. In both groups, advanced life support was performed as recommended by the AHA. Measurements and Main Results: Rate of patients regaining a spontaneous circulation (ROSC), hospital discharge rate, and mean carbon dioxide content during resuscitation were recorded. ROSC rates in groups 1 and 2 were 40% and 38.5%, respectively. Four patients (13.3%) in group 1 and three patients (11.5%) in group 2 were discharged (group 1 v group 2: n.s.). Anatomic conditions precluded the application of ACD CPR in 5 patients. The new technique was found to impose greater physical efforts than STD CPR. Capnography was performed in 23 patients (mean value: STD CPR: 11.9 ± 4.7 mmHg, ACD CPR: 13.7 ± 4.9 mmHg [n.s.]). Conclusions: ACD CPR did not improve, outcome and practical performance was complicated. Therefore, this technique should not be performed routinely, or without strict supervision in prehospital cardiac arrest.