Active Abdominal Compression-decompression Cardiopulmonary Resuscitation Research Articles

COMPARISON BETWEEN ACTIVE ABDOMINAL COMPRESSION-DECOMPRESSION CARDIOPULMONARY RESUSCITATION AND STANDARD CARDIOPULMONARY RESUSCITATION IN ASPHYCTIC CARDIAC ARREST RATS WITH MULTIPLE RIB FRACTURES.

Background: Active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) is potentially more effective for cardiac arrest (CA) with multiple rib fractures. However, its effect on survival rates and neurological outcomes remains unknown. This study aimed to assess if AACD-CPR improves survival rates and neurological outcomes in a rat model of asphyctic CA with multiple rib fractures. Methods: Adult male Sprague-Dawley rats were randomized into three groups-AACD group (n = 15), standard cardiopulmonary resuscitation (STD-CPR) group (n = 15), and sham group (n = 10)-after bilateral rib fractures were surgically created and endotracheal intubation was performed. AACD-CPR and STD-CPR groups underwent 8 min of asphyxia followed by different CPR techniques. The sham group had venous catheterization only. Physiological variables and arterial blood gases were recorded at baseline and during a 4-h monitoring period. Neurological deficit scores (NDSs) and cumulative survival rates were assessed at 24, 48, and 72 h. NDS, serum biomarkers, and hippocampal neuron analysis were used to evaluate neurological outcomes. Results: No statistical differences were observed in the return of spontaneous circulation (ROSC), 24-, 48-, and 72-h survival rates between the AACD-CPR and STD-CPR groups. AACD-CPR rats had lower serum levels of neuron-specific enolase and S100B at 72 h post-ROSC, and higher NDS at 72 h post-ROSC compared with STD-CPR animals. Cellular morphology analysis, hematoxylin and eosin staining, and TUNEL/DAPI assays showed more viable neurons and fewer apoptotic neurons in the AACD-CPR group than in the STD-CPR group. Conclusions: AACD-CPR can achieve similar survival rates and better neurological outcome after asphyxial CA in rats with multiple rib fractures when compared with STD-CPR.

Efficacy and safety of active abdominal compression-decompression versus standard CPR for cardiac arrests: A systematic review and meta-analysis of 17 RCTs.

Active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR), which applies to cardiac arrests with contraindication of standard chest compressions (SCC) CPR, has been utilized in cardiac arrest. However, the efficacy and safety of AACD-CPR still remained controversy. This analysis was designed to comprehensively compare AACD versus SCC-CPR in patients with cardiac arrest. We searched the Cochrane Library, PubMed, EMBASE, Web of Science and CNKI up to April 22, 2019. Mean difference (MD) and risk ratio (RR) with its 95% confidence intervals (CIs) were estimated to compare outcomes of the groups. Our primary outcomes were restoration of spontaneous circulation (ROSC) and short-term survival. Two reviewers assessed trial quality and extracted data independently. All statistical analyses were performed using standard statistical procedures provided in Review Manager 5.2 and Stata 12.0. A total of seventeen studies (N = 1647 patients) were identified for the present analysis. Compared with standard CPR, AACD-CPR was superior in restoration of spontaneous circulation (ROSC) and short-term survival, with pooled RRs of 1.38 (95% CI 1.23-1.55; P < 0.00001) and RRs of 2.05 (95% CI 1.69-2.50; P < 0.00001) respectively. In addition, significant superiority of AACD-CPR was found in incidence of fracture, long-term survival, pressure of end-tidal carbon dioxide (PETCO2), coronary perfusion pressure (CPP) and adverse events. No significant difference was observed in incidence of vomiting. Generally, in this combined analysis we found a statistically significant improvement in survival and ROSC with the use of AACD-CPR as compared with the use of standard CPR. There was also significant improvement in incidence of fracture, long-term survival, PETCO2 and CPP with AACD-CPR in comparison with standard CPR; results were not statistically different between the groups regarding to vomiting rate and adverse events. The standardized, diversified and individualized methods of clinical operation of AACD-CPR need exploration and expectingly serve as a guideline for clinical application of AACD-CPR in the future.

Chinese expert consensus on cardiopulmonary resuscitation guidelines for the operation of active abdominal compression-decompression cardiopulmonary resuscitation

The 2016 National consensus on cardiopulmonary resuscitation in China highlights the survival circle of cardiopulmonary resuscitation (CPR). The cycle of survival covers three periods, pre-arrest phase, intra-arrest phase and post-resuscitation phase on cardiac arrest. In the pre-arrest phase, "three-prevention" policies should be adopted, which are precaution, pre-warning and early identification. During intra-arrest phase, CPR should be carried out with "three-ways" strategies, which are standardization, diversification and individuation. The "three lives" general plans should be considered during the post-resuscitation phase, which are demutation, transcending and extension. The consensus is a Chinese wisdom to understand the essential law of CPR. The key to the success of resuscitation is to grasp "three-ways" according to individual conditions. Cardiopulmonary Resuscitation Specialized Committee of Chinese Research Hospital Association organized experts in relevant fields to promulgate Chinese expert consensus on cardiopulmonary resuscitation guidelines for the operation of active abdominal compression-decompression cardiopulmonary resuscitation through clinical practice, starting from the actual situation of patients with cardiac arrest and combining with the field environment. The standardized, diversified and individualized methods of clinical operation of active abdominal compression-decompression CPR (AACD-CPR) are introduced in detail. It will serve as a guideline for clinical application of AACD-CPR.

Clinical effect of cardiopulmonary resuscitation with active abdominal compression-decompression

To explore the resuscitation effect of active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) on patients with cardiac arrest. The patients with cardiac arrest admitted to emergency medical center of Hainan General Hospital from June 2014 to January 2016 were enrolled, who were satisfied with the indication of AACD-CPR and had no contraindication for AACD-CPR, and with 40-150 kg weight and over 16 years old. All of enrolled patients were given mechanical ventilation and conventional drug rescue. At the same time, AACD-CPR was performed with the active abdominal compression-decompression device, the rhythm of abdominal compression-decompression was 100 bmp and the ratio of compression time to lift time was 1:1, the pressure intensity was approximately 50 kg and the lifting intensity was approximately 30 kg. Heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2) and blood lactic acid (Lac) were recorded before and after CPR, and restoration of spontaneous circulation (ROSC) were calculated. Forty-one patients with cardiac arrest were enrolled, with 22 males and 19 females, and the age between 15 years old and 89 years old, with an average (66.5±18.8) years old. The etiologies of cardiac arrest were followed: cardiogenic for 10 cases, non-cardiogenic for 18 cases, and unknown causes for 13 cases. The rate of ROSC in patients with AACD-CPR was 19.5% (8/41). During the resuscitation, the HR, MAP and SpO2 of those patients were significantly improved compared with those index suffering the cardiac arrest [HR (bmp): 67.0 (48.0, 105.0) vs. 0.0 (0.0, 11.5), MAP (mmHg, 1 mmHg = 0.133 kPa): 23.0 (16.0, 37.0) vs. 0.0 (0.0, 0.0), SpO2: 0.79 (0.45, 0.90) vs. 0.00 (0.00, 0.32), all P < 0.01]. During the resuscitation and 0.5 hours after ROSC, the indexes of the ROSC patients were significantly improved compared with those suffering cardiac arrest [HR (bmp): 88.5 (53.8, 105.0), 94.5 (72.5, 129.3) vs. 0.0 (0.0, 17.3); MAP (mmHg): 48.0 (41.3, 66.0), 54.0 (42.0, 72.5) vs. 0.0 (0.0, 0.0); SpO2: 0.74 (0.64, 0.80), 0.89 (0.81, 0.93) vs. 0.00 (0.00, 0.42); all P < 0.05]; in addition, the Lac of patients was not increased in the resuscitation and 0.5 hours after ROSC compared with the status before cardiopulmonary resuscitation (mmol/L: 4.44±1.66, 3.71±1.33 vs. 3.95±1.71, both P > 0.05). Besides, the ROSC rate of patients who suffered cardiac arrest before pre-hospital care or in emergency ward [11.1% (2/18)] were lower than those the patients who suffered cardiac arrest in emergency intensive care unit [EICU, 26.1% (6/23)]; while the cardiac arrest patients who didn't experienced AACD-CPR until they got complications such as thoracic rib fracture after standard cardiopulmonary resuscitation (STD-CPR), the ROSC rate of those patients in pre-hospital care or in emergency ward [10.0% (1/10)] were lower than the ROSC rate of the patients who suffered cardiac arrest in EICU [20.0% (4/20)], but there was no significant difference between the two groups (both P > 0.05). AACD-CPR is effective in the treatment of sudden cardiac arrest patients with contraindication of chest compression, and makes up for the deficiency of STD-CPR.

Effect analysis of abdominal compression-decompression device in patients with cardiopulmonary resuscitation in pre-hospital first aid

To investigate the effect of active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) in patients with pre-hospital respiratory and cardiac arrest. Forty-five patients with respiratory and cardiac arrest, and with contraindication of chest compression admitted to Baiyin Central Hospital of Gansu Province from March 2012 to September 2018 were enrolled, and they were divided into two groups according to random number table. AACD-CPR (abdominal compression-decompression group, n = 24) and cardiopulmonary resuscitation (CPR) with unarmed abdominal compression (unarmed abdominal pressure group, n = 21) were performed respectively. The success rate of rescue was observed in the two groups, and the changes in heart rate (HR), pulse oxygen saturation (SpO2) and blood pressure 30 minutes after CPR in patients with restoration of spontaneous circulation (ROSC) were observed. Among the 24 patients in the abdominal compression-decompression group, 5 patients (20.83%) had ROSC, and 2 patients (9.52%) had ROSC in 21 patients of the unarmed abdominal pressure group. The success rate of resuscitation in the abdominal compression-decompression group was significantly higher than that in the unarmed abdominal pressure group (P < 0.05). HR of ROSC patients at 30 minutes of CPR in abdominal compression-decompression group was significantly lower than that in unarmed abdominal compression group (bpm: 139.45±5.08 vs. 147.62±5.24, P < 0.05), and SpO2 and blood pressure were significantly higher than those in unarmed abdominal compression group with significant differences [SpO2: 0.92±0.03 vs. 0.85±0.03, systolic blood pressure (SBP, mmHg, 1 mmHg = 0.133 kPa): 118.23±3.26 vs. 98.51±3.10, diastolic blood pressure (DBP, mmHg): 60.10±2.50 vs. 56.36±2.45, all P < 0.05]. The effect of AACD-CPR was superior to that of unarmed abdominal pressure CPR, which had higher application value to rescue patients with respiratory and cardiac arrest with chest pressure contraindication.

Research to Observe the Hemodynamic Changes and Cardiac Function in Active Abdominal Compression-decompression Cardiopulmonary Resuscitation

Objective: Compare the hemodynamic changes and cardiac function between active abdominal compressiondecompression cardiopulmonary resuscitation and standard cardiopulmonary resuscitation. Methods: A prospective controlled trial was conducted. The patients staying in EICU or ICU were the study subjects which were divided into active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) group and standard cardiopulmonary resuscitation (STD-CPR) group randomly. Central venous pressure (CVP), diastolic blood pressure (DBP) and coronary perfusion pressure (CPP) were recorded continuously. Transesophageal echocardiography (TEE) was used to observe the cardiac valves and assess left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), left ventricular ejection fraction (LVEF) during CPR. Results: During CPR, LVEDV of two groups both decreased compared with pre-cardiac arrest, which was not statistically significant(P>0.05). LVEDV in AACD-CPR group was larger than STD-CPR group during CPR. But there was not statistically significant (P>0.05). During CPR, LVESV of two groups both increased compared with pre-cardiac arrest, which was statistically significant(P<0.01). LVESV in AACD-CPR group was larger than STDCPR group?P<0.05). But there was not statistically significant(P>0.05). Both AACD-CPR group and STD-CPR group showed significantly decreased LVEF compared with pre-cardic arrest, of which the difference was statistically significant(P<0.01). LVEF in STD-CPR group was higher than AACD-CPR group and there was a tatistically significant difference between them?P<0.05). When compressing chest , mitral valve and tricuspid valve were open and aortic valve and pulmonary valve were closed during the 8 patients of the STD-CPR group. Conclusion: During chest compression, heart pump took effect in a part of patients. However, during abdominal compression, heart was just a channel that blood flowed. The cardiac function in STD-CPR was superior to AACDCPR. However, both of them can produce effective haemodynamics. So, we suggested that AACD-CPR could be used in the patients with the contraindication of STD-CPR.

Predictive value of partial pressure of end-tidal carbon dioxide on the effect of active abdominal compression-decompression cardiopulmonary resuscitation and serum S100B protein on cerebral function

To explore the predictive value of partial pressure of end-tidal carbon dioxide (PETCO2) on the effect of active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) and serum S100B protein on cerebral function. 142 adult patients with in-hospital cardiac arrest (IHCA) AACD-CPR in Zhengzhou People's Hospital, Affiliated Southern Medical University from September 2014 to December 2017 were enrolled. Patients were divided into successful group and failure group according to restoration of spontaneous circulation (ROSC) or not; and then according to Glasgow-Pittsburgh cerebral performance categories (CPC) one month after ROSC, the successful group was divided into good prognosis group (CPC 1-2) and poor prognosis group (CPC 3-5) further. The variations of hemodynamic, arterial blood gas index, PETCO2 and serum S100B protein level (25 healthy subjects as normal S100B protein level reference value) during the recovery were analyzed. The predictive value of PETCO2 on the effect of AACD-CPR and serum S100B protein on cerebral function of successful resuscitation patients were analyzed by receiver operating characteristic curve (ROC). (1) According to the traditional qualitative indexes, such as pulsation of the large artery, redness of lips and extremities, spontaneous fluctuation of chest, narrowing of pupil, existence of shallow reflex, etc, 54 in 142 patients with IHCA were successfully resuscitated; 57 cases were successfully resuscitated through the guidance of PETCO2, there was no significant difference between the two groups (χ2 = 0.133, P = 0.715). With the AACD-CPR, 142 CA patients' arterial partial pressure of oxygen (PaO2), arterial blood carbon dioxide partial pressure (PaCO2) were all improved with different degrees; heart rate (HR), mean arterial pressure (MAP), PaO2 and PaCO2 were further improved at 20 minutes after ROSC. At beginning of AACD-CPR, PETCO2 of both groups were about 10 mmHg (1 mmHg = 0.133 kPa). PETCO2 was gradually rising to above 20 mmHg in successful group during AACD-CPR process; the failed group increased slightly within 2-5 minutes, then gradually decreased to below 20 mmHg, there was a significant difference in PETCO2 between the two groups at each time. The area under the ROC (AUC) of PETCO2 at CPR 20 minutes in predicting the outcome of the resuscitation was 0.969, 95% confidence interval (95%CI) was 0.943-0.995 (P = 0.000), when the cut-off value of PETCO2 was 24.25 mmHg, the sensitivity was 90.7%, and the specificity was 96.6%. (2) The level of serum S100B protein at 0.5 hour after ROSC in the good prognosis group and the poor prognosis group were significant higher than that of the normal control group; there was no significant difference between poor prognosis group and good prognosis group. S100B protein concentration of the poor prognosis group reached the peak within 3-6 hours, then gradually decreased, and was higher than that of the normal control group at ROSC 72 hours; the good prognosis was gradually decreased and recovered to normal control group within ROSC 72 hours. The AUC of S100B at 3 hours after ROSC on cerebral function prognosis prediction was 0.925, 95%CI was 0.867-0.984 (P = 0.000), when the cut-off value of S100B protein was 1.215 μg/L, the sensitivity was 85.2%, and the specificity was 85.5%. The variation of PETCO2 can be used as an objective index to predict the success of AACD-CPR, and serum S100B protein can be used as an objective clinical index to predict cerebral function after AACD-CPR, both of which have some reference and guiding significance for clinical treatment.

Effects of active abdominal compression-decompression CPR on oxygen metabolism and prognosis in patients with cardiac arrest

To analyze the effect of active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) and standard cardiopulmonary resuscitation (STD-CPR) on oxygen metabolism and prognosis of patient with cardiac arrest (CA), and to evaluate the treatment effect of AACD-CPR. Patients with CA, CA time less than 30 minutes, and without STD-CPR and AACD-CPR contraindications admitted to the Zhengzhou People's Hospital from October 1st 2015 to May 31st 2017 were enrolled. The patients were divided into STD-CPR group and AACD-CPR group according to random number table. All patients were given the same rescue measures, if required to give defibrillation; STD-CPR group was operated according to the 2015 American Heart Association (AHA) CPR guidelines; AACD-CPR group was recovered using abdominal lifting and compression cardiopulmonary resuscitation instrument. The oxygen metabolism, hemodynamic, arterial blood gas and prognostic indicators were recorded in the two groups during the resuscitation. A total of 69 cases, with STD-CPR group of 34 cases and AACD-CPR group of 35 cases were enrolled finally. (1) The oxygen metabolism: during the recovery, compared with STD-CPR group, arterial blood oxygen content (CaO2), arterial-venous oxygen content difference (avDO2), the oxygen carrying capacity (DO2), oxygen consumption (VO2) in AACD-CPR group were significantly increased [CaO2 (mL/L): 156±15 vs. 142±19, avDO2 (mL/L): 83±14 vs. 73±13, DO2 (mL/min): 248±51 vs. 208±54, VO2 (mL/min): 134±29 vs. 118±32, all P < 0.05], but there were no significant differences in cardiac output (CO) and mixed venous oxygen content (CvO2). (2) Hemodynamic and arterial blood gas: there were no significant differences in the base values of the heart rate (HR), mean arterial pressure (MAP), pH value, pulse oxygen saturation (SpO2), arterial oxygen pressure (PaO2), arterial partial pressure of carbon dioxide (PaCO2), and blood lactate (Lac) between two groups. In the recovery process, MAP, pH value, SpO2, PaO2 of two groups were increased, while PaCO2 and Lac were decreased. Except MAP of STD-CPR group was slightly higher than AACD-CPR group, the change tendency of AACD-CPR group was more obvious in each index obviously [pH value difference: 0.10±0.15 vs. 0.02±0.13, SpO2 difference: 0.311±0.255 vs. 0.159±0.232, PaO2 difference (mmHg, 1 mmHg = 0.133 kPa): 12.96±21.84 vs. 3.01±13.56, PaCO2 difference (mmHg): -9.91±11.17 vs. -3.52±13.87, Lac value difference (mmol/L): -0.64±0.61 vs. -0.31±0.58, all P < 0.05]. (3) Prognosis: compared with STD-CPR group, the restoration of spontaneous circulation (ROSC) rate in AACD-CPR group was slightly increased (22.9% vs. 8.8%, P > 0.05), but the ROSC time in AACD-CPR group was significantly shortened (minutes: 9.59±2.67 vs. 11.83±3.05, P < 0.01), nerve function defect score (NDS) was significantly decreased at 1, 2 weeks (26.45±6.42 vs. 30.73±7.38, 19.25±6.27 vs. 22.64±5.63, both P < 0.05), and the 2-week survival was slightly increased (17.1% vs. 5.9%, P > 0.05). AACD-CPR is similar to STD-CPR in improving hemodynamics of CA patients, but has advantage in the blood oxygen supply for tissues and organs, and the neurological function prognosis is better.

Chest compression on CPR and active abdominal on CPR

Chest compression cannot be effectively applied under certain situations, such as chest wall deformity, rib fracture, or hemopneumothorax. Active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) could reach better resuscitation outcomes in certain cardiac arrest (CA) patients. AACD-CPR can strengthen the high quality of cardiopulmonary resuscitation (CPR) in "2015 American Heart Association for cardiopulmonary resuscitation and emergency cardiovascular care update guide". The two methods can complement each other in opposite direction, and implement the "2016 national consensus on cardiopulmonary resuscitation on CPR in China", which is an important part of the wisdom to the Chinese CPR. In the article, we compared chest compression in standard single rescuer cardiopulmonary resuscitation (STD-CPR) and AACD-CPR with their aspects of the cause, mechanism, methods and application. We will provide an important reference about techniques of STD-CPR and AACD-CPR.

Effect of Active Abdominal Compression-Decompression Cardiopulmonary Resuscitation on Oxygen Metabolism and Prognosis in Patients with Cardiac Arrest

Effect of Active Abdominal Compression-Decompression Cardiopulmonary Resuscitation on Oxygen Metabolism and Prognosis in Patients with Cardiac Arrest