Abstract
Over the past 25 years a variety of alternatives to standard manual CPR have been developed in an effort to improve ventilation or perfusion during cardiac arrest and ultimately to improve survival. Compared with standard CPR, these techniques and devices typically require more personnel, training, or equipment, or they apply to a specific setting. Maximum benefits are reported when adjuncts are begun early in the treatment of cardiac arrest, so that the use of these alternatives to CPR is often limited to the hospital setting. To date no adjunct has consistently been shown to be superior to standard manual CPR for out-of-hospital basic life support, and no device other than a defibrillator has consistently improved long-term survival from out-of-hospital cardiac arrest. The data reported here is limited to clinical trials, so most animal data is excluded from this section. ### High-Frequency Chest Compressions High-frequency (>100 per minute) manual or mechanical chest compressions have been studied as a technique for improving resuscitation from cardiac arrest.1–4 The sparse animal and human data available show mixed results. One clinical trial of 9 patients showed that high-frequency (120 per minute) chest compressions improved hemodynamics over standard CPR (LOE 4).5 The use of high-frequency chest compressions for cardiac arrest by adequately trained rescue personnel can be considered, but there is insufficient evidence to recommend for or against its use (Class Indeterminate). ### Open-Chest CPR No prospective randomized studies of open-chest CPR for resuscitation have been published. Four relevant human studies were reviewed: 2 were performed to treat in-hospital cardiac arrest following cardiac surgery (LOE 46; LOE 57), and 2 were performed after out-of-hospital cardiac arrest (LOE 48; LOE 59). The observed benefits of open-chest cardiac massage were improved coronary perfusion pressure9 and increased return of spontaneous circulation (ROSC).8 Open-chest CPR should be …
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