Standard Cardiopulmonary Resuscitation Group Research Articles

A randomized clinical trial of active compression-decompression CPR vs. standard CPR in out-of-hospital cardiac arrest in two cities: J Am Med Assoc 1995; 273/16 (1261–1268)

Objective. —To compare the effectiveness of active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) with a handheld suction device vs standard manual CPR in victims of out-of-hospital cardiopulmonary arrest. Design. —Prospective randomized clinical trial with crossover group design. Setting. —Emergency medical services (EMS) of a large (San Francisco) and medium-sized (Fresno) city in California. Patients. —All normothermic adult victims of out-of-hospital, nontraumatic cardiac arrest on whom CPR was performed by first responders. Intervention. —Patients were randomized to receive either standard manual CPR according to American Heart Association guidelines or ACD CPR, on first-responder contact. Main Outcome Measures. —Return of spontaneous circulation, admission to the intensive care unit, survival to hospital discharge, and neurological function at hospital discharge. Results. —The ACD group (n=117 in Fresno; n=297 in San Francisco) and standard group (n=136 in Fresno; n=310 in San Francisco) were similar with regard to demographic and prognostic variables, such as age, witnessed arrest and bystander CPR frequency, and initial cardiac rhythm. Average interval from 911 call activation to EMS responder arrival was 6.4 minutes in Fresno and 4.0 minutes in San Francisco. In Fresno, there was no difference between the ACD group and standard CPR group in return of spontaneous circulation (17% vs 20%; P =.68), hospital admission (16% vs 20%; P =.56), hospital discharge (5% vs 7%; P =.64), or cerebral performance category score at discharge (1.5 vs 1.6; P =.90). Similarly, in San Francisco there was no difference between the ACD group and standard CPR group in return of spontaneous circulation (19% vs 21%; P =.65), hospital admission (13.5% vs 14.5%; P =.79), hospital discharge (4.7% vs 5.5%; P =.80), or cerebral performance category score at discharge (2.2 vs 2.6; P =.31). There was no increase in significant complications associated with the use of ACD CPR. Conclusion. —There was no improvement in outcome with ACD CPR in out-of-hospital cardiac arrest in these two cities. Differences in study design, demographics, EMS systems, response intervals, training, and technique performance may contribute to the lack of improvement in initial resuscitation with ACD CPR compared with previous studies. Future research needs to control these variables to determine the reason for these differences in outcome. ( JAMA . 1995;273:1261-1268)

A Randomized Clinical Trial of Active Compression-Decompression CPR vs Standard CPR in Out-of-Hospital Cardiac Arrest in Two Cities

To compare the effectiveness of active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) with a handheld suction device vs standard manual CPR in victims of out-of-hospital cardiopulmonary arrest. Prospective randomized clinical trial with crossover group design. Emergency medical services (EMS) of a large (San Francisco) and medium-sized (Fresno) city in California. All normothermic adult victims of out-of-hospital, nontraumatic cardiac arrest on whom CPR was performed by first responders. Patients were randomized to receive either standard manual CPR according to American Heart Association guidelines or ACD CPR, on first-responder contact. Return of spontaneous circulation, admission to the intensive care unit, survival to hospital discharge, and neurological function at hospital discharge. The ACD group (n = 117 in Fresno; n = 297 in San Francisco) and standard group (n = 136 in Fresno; n = 310 in San Francisco) were similar with regard to demographic and prognostic variables, such as age, witnessed arrest and bystander CPR frequency, and initial cardiac rhythm. Average interval from 911 call activation to EMS responder arrival was 6.4 minutes in Fresno and 4.0 minutes in San Francisco. In Fresno, there was no difference between the ACD group and standard CPR group in return of spontaneous circulation (17% vs 20%; P = .68), hospital admission (16% vs 20%; P = .56), hospital discharge (5% vs 7%; P = .64), or cerebral performance category score at discharge (1.5 vs 1.6; P = .90). Similarly, in San Francisco there was no difference between the ACD group and standard CPR group in return of spontaneous circulation (19% vs 21%; P = .65), hospital admission (13.5% vs 14.5%; P = .79), hospital discharge (4.7% vs 5.5%; P = .80), or cerebral performance category score at discharge (2.2 vs 2.6; P = .31). There was no increase in significant complications associated with the use of ACD CPR. There was no improvement in outcome with ACD CPR in out-of-hospital cardiac arrest in these two cities. Differences in study design, demographics, EMS systems, response intervals, training, and technique performance may contribute to the lack of improvement in initial resuscitation with ACD CPR compared with previous studies. Future research needs to control these variables to determine the reason for these differences in outcome.

The optimum timing of resuscitative thoracotomy for non-traumatic out-of-hospital cardiac arrest

Open-chest cardiopulmonary resuscitation (CPR) is a promising method for non-traumatic cardiac arrest. In this preliminary study, we investigated the optimum timing of thoracotomy which brings high rate of return of spontaneous circulation (ROSC) and keeps the incidence of unnecessary thoracotomy minimal. Ninety-five adult patients with non-traumatic out-of-hospital cardiac arrest were analyzed. Of those, 26 patients were treated by the open-chest CPR in a prospective consecutive fashion. In this group, the ROSC rate was investigated in connection with the interval from hospital arrival, or ambulance call, to thoracotomy. Another 69 patients were treated by standard CPR. In this uncontrolled group, the interval from arrival at hospital to ROSC was investigated to define the 'natural hospital course' by the conventional treatment. Patient characteristics in the open-chest CPR group and the standard CPR group were similar. In the open-chest CPR group, 15 patients obtained ROSC. There was a tendency that the ROSC rate was highest in the patients with thoracotomy within 5 min of hospital arrival and declined as the timing of thoracotomy was delayed. Similar tendency was noted when the timing of thoracotomy was counted from the ambulance call. In the standard CPR group, only two patients obtained ROSC during the initial 5 min of hospital course. These results suggest that thoracotomy within 5 min of hospital arrival brings the highest ROSC rate while keeps the incidence of unnecessary thoracotomy acceptable.

Survival from in-hospital cardiac arrest with interposed abdominal counterpulsation during cardiopulmonary resuscitation

<h3>Objective.</h3> —To determine whether interposed abdominal counterpulsation (IAC) during standard cardiopulmonary resuscitation (CPR) improves outcome in patients experiencing in-hospital cardiac arrest. <h3>Design and Setting.</h3> —Randomized controlled trial in a university-affiliated hospital. <h3>Patients.</h3> —Patients experiencing in-hospital cardiac arrest during a 6-month period. <h3>Interventions.</h3> —Patients were randomized to receive either IAC during CPR or standard CPR in the event of cardiac arrest. Abdominal compressions were performed during the relaxation phase of chest compression, corresponding to CPR diastole, at a rate of 80/min to 100/min. <h3>Main Outcome Measures.</h3> —The three end points studied were (1) return of spontaneous circulation, (2) survival 24 hours after resuscitation, and (3) survival to hospital discharge. In addition, we examined neurological outcome in those patients surviving to hospital discharge. <h3>Results.</h3> —During the study period there were 135 resuscitation attempts in 103 patients. Return of spontaneous circulation was significantly greater in the group receiving IAC during CPR than in the group receiving standard CPR (51% vs 27%,<i>P</i>=.007). At hospital discharge, a significantly greater proportion of patients was alive in the IAC group than in the control group (25% vs 7%,<i>P</i>=.02). Eight (17%) of 48 patients who received IAC during CPR survived to hospital discharge neurologically intact, compared with only three (6%) of 55 patients from the standard CPR group (not significant). <h3>Conclusions.</h3> —We conclude that the addition of IAC to standard CPR may improve meaningful survival following in-hospital cardiac arrest. The optimal use of this technique awaits further clinical trials. (<i>JAMA</i>. 1992;267:379-385)

Survival From In-Hospital Cardiac Arrest With Interposed Abdominal Counterpulsation During Cardiopulmonary Resuscitation

--To determine whether interposed abdominal counterpulsation (IAC) during standard cardiopulmonary resuscitation (CPR) improves outcome in patients experiencing in-hospital cardiac arrest. --Randomized controlled trial in a university-affiliated hospital. --Patients experiencing in-hospital cardiac arrest during a 6-month period. --Patients were randomized to receive either IAC during CPR or standard CPR in the event of cardiac arrest. Abdominal compressions were performed during the relaxation phase of chest compression, corresponding to CPR diastole, at a rate of 80/min to 100/min. --The three end points studied were (1) return of spontaneous circulation, (2) survival 24 hours after resuscitation, and (3) survival to hospital discharge. In addition, we examined neurological outcome in those patients surviving to hospital discharge. --During the study period there were 135 resuscitation attempts in 103 patients. Return of spontaneous circulation was significantly greater in the group receiving IAC during CPR than in the group receiving standard CPR (51% vs 27%, P = .007). At hospital discharge, a significantly greater proportion of patients was alive in the IAC group than in the control group (25% vs 7%, P = .02). Eight (17%) of 48 patients who received IAC during CPR survived to hospital discharge neurologically intact, compared with only three (6%) of 55 patients from the standard CPR group (not significant). --We conclude that the addition of IAC to standard CPR may improve meaningful survival following in-hospital cardiac arrest. The optimal use of this technique awaits further clinical trials.