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June 3, 1992, Vol 267, No. 21 >
ARTICLE | June 3, 1992

Active Compression-Decompression: Title and subTitle BreakA New Method of Cardiopulmonary Resuscitation FREE

Todd J. Cohen, MD; Kelly J. Tucker, MD; Keith G. Lurie, MD; Rita F. Redberg, MD; John P. Dutton; Kathy A. Dwyer, RN; Theresa M. Schwab; Michael C. Chin; Alan M. Gelb, MD; Melvin M. Scheinman, MD; Nelson B. Schiller, MD; Michael L. Callaham, MD
[+] Author Affiliations

Presented at the 41st Annual Scientific Session of the American College of Cardiology, Dallas, Tex, April 13, 1992.

Reprint requests to Director of Electrophysiology, Cardiology Division, North Shore University Hospital— Cornell University Medical College, 300 Community Dr, Manhasset, NY 11030 (Dr Cohen).


JAMA. 1992;267(21):2916-2923. doi:10.1001/jama.1992.03480210078036
Text Size: A A A
Published online
Article
References

Objective.  —To describe and compare with standard cardiopulmonary resuscitation (CPR) in humans a new form of CPR that involves both active compression and active decompression of the chest.

Design.  —Patients in cardiac arrest in whom standard advanced cardiac life support failed were randomized to receive 2 minutes of either standard or active compression-decompression (ACD) CPR using a custom, hand-held suction device, followed by 2 minutes of the alternate technique. The ACD device was applied midsternum and used to perform CPR according to the guidelines of the American Heart Association: 80 compressions per minute, compression depth of 3.8 to 5 cm, 50% duty cycle, and constant-volume ventilation. Mechanical Thumper CPR was also compared in five patients. End-tidal carbon dioxide (ETco2) concentrations and hemodynamic variables were measured. Transesophageal Doppler echocardiography was used to assess contractility, the velocity time integral (an analogue of cardiac output), and diastolic myocardial filling times.

Results.  —Ten patients were enrolled. The mean±SD ETco2 was 4.3±3.8 mm Hg with standard CPR and 9.0±3.9 mm Hg with ACD CPR (P<.0001). Systolic arterial pressure with standard CPR was 52.5±14.0 mm Hg and with ACD CPR, 88.9±24.7 mm Hg (P<.003). The velocity time integral increased from 7.3±2.6 cm with standard CPR to 17.5±5.6 cm with ACD CPR (P<.0001), and diastolic filling times increased from 0.23±09 seconds with standard CPR to 0.37±12 seconds with ACD CPR (P<.004). Mechanical Thumper CPR consistently underperformed both standard and ACD CPR. Minute ventilation obtained in four patients during ACD CPR without endotracheal ventilation was 6.6±0.9 L/min. After 1 hour of standard CPR failed, three of 10 patients randomized to ACD CPR rapidly converted to a hemodynamically stable rhythm following 2 minutes of ACD CPR.

Conclusion.  —ACD CPR is a simple manual technique that improved cardiopulmonary circulation in 10 patients during cardiac arrest. Although ACD CPR may have produced a return of spontaneous circulation in three patients refractory to standard measures, its impact on survival when used early in cardiac arrest remains to be determined.(JAMA. 1992;267:2916-2923)

REFERENCES

1 +
Eisenberg MS, Bergner L, Hallstrom A.  Cardiac resuscitation in the community: importance of rapid provision and implications for program planning. JAMA . 1979;;241:1905.
2 +
Eisenberg MS, Copass MK, Hallstrom AP, et al.  Treatment of out-of-hospital cardiac arrests with rapid defibrillation by emergency medical technicians. N Engl J Med . 1980;;302:1379-1383.
3 +
Eisenberg MS, Hallstrom A, Bergner L.  Long-term survival after out-of-hospital cardiac arrest. N Engl J Med . 1982;;306:1340-1343.
4 +
Peatfield RC, Sillett RW, Taylor D, McNichol MW.  Survival after cardiac arrest in hospital. Lancet . 1977;; 2:1223-1225.
5 +
Bedell SE, Delbanco TL, Cook EF, Epstein FH.  Survival after cardiopulmonary resuscitation in the hospital. N Engl J Med . 1983;;309:569-576.
6 +
Del Guercio LRM, Coomaraswamy RP, State D.  Cardiac output and other hemodynamic variables during external cardiac massage in man. N Engl J Med . 1963;;269:1398-1404.
7 +
Koehler RC, Chandra N, Guerci AD, et al.  Augmentation of cerebral perfusion by simultaneous chest compression and lung inflation with abdominal binding after cardiac arrest in dogs. Circulation . 1983;;67:266-275.
8 +
Walker JW, Bruestle JC, White BC, et al.  Perfusion of cerebral cortex by use of abdominal counterpulsation during cardiopulmonary resuscitation. Am J Emerg Med . 1984;;2:391-393.
9 +
Chandra N, Weisfeldt M, Tsitlik J, et al.  Augmentation of cardiac flow during cardiopulmonary resuscitation by ventilation at high airway pressure simultaneous with chest compression. Am J Cardiol . 1981;;48: 1053-1063.
10 +
Chandra NC, Beyar R, Halperin HR, et al.  Vital organ perfusion during assisted circulation by manipulation of intrathoracic pressure. Circulation . 1991;;84: 279-286.
11 +
Berryman CR, Phillips GM.  Interposed abdominal compression-CPR in human subjects. Ann Emerg Med . 1984;;13:226-229.
12 +
Kaplan BC, Civetta JM, Nagel EL, et al.  The military antishock trousers in civilian pre-hospital emergency care. J Trauma . 1973;;13:843-848.
13 +
Criley JM, Blaufuss AH, Kissel GL.  Cough-induced cardiac compression: self-administered form of cardiopulmonary resuscitation. JAMA . 1976;;236:1246-1250.
14 +
Sack J B, Kesselbrenner MB, Jarrad A, Bregman D.  Effect of interposed abdominal counterpulsation on resuscitation outcome during asystole and electromechanical dissociation. J Am Coll Cardiol . 1991;;17:179a.
15 +
Spalding JMK, Smith AC. Clinical Practice and Physiology of Artificial Respiration . Oxford, England: Blackwell Scientific Publications; 1963;.
16 +
Krischer JP, Fine EG, Weisfeldt ML, et al.  Comparison of prehospital conventional and simultaneous compression-ventilation cardiopulmonary resuscitation. Crit Care Med . 1989;;17:1263-1269.
17 +
Bircher N, Safar P.  Comparison of standard and 'new' closed-chest CPR and open-chest CPR in dogs. Crit Care Med . 1981;;9:384-385.
18 +
Niemann JT, Rosborough JP, Ung S, et al.  Hemodynamic effects of continuous abdominal binding during cardiac arrest and resuscitation. Am J Cardiol . 1984;;53:269-274.
19 +
Niemann JT, Rosborough JP, Niskanen RA, et al.  Mechanical 'cough' cardiopulmonary resuscitation during cardiac arrest in dogs. Am J Cardiol . 1985;;55:199-204.
20 +
Halperin HR, Guerci AD, Chandra N, et al.  Vest inflation without simultaneous ventilation during cardiac arrest in dogs: improved survival from prolonged cardiopulmonary resuscitation. Circulation . 1986;;74: 1407-1415.
21 +
Bircher N, Safar P, Stewart R.  A comparison of standard, MAST-augmented and open-chest CPR in dogs: a preliminary investigation. Crit Care Med . 1980;;8:147-152.
22 +
Berryman CR, Phillips GM.  Interposed abdominal compression-CPR in human subjects. Ann Emerg Med . 1984;;13:226-229.
23 +
Howard M, Carrubba C, Foss F, et al.  Interposed abdominal compression-CPR: its effects on parameters of coronary perfusion in human subjects. Ann Emerg Med . 1987;;16:253-259.
24 +
Krischer JP, Fine EG, Weisfeldt ML, Guerci AD, Nagel G, Chandra N.  Comparison of prehospital conventional and simultaneous compression-ventilation cardiopulmonary resuscitation. Crit Care Med . 1989;; 17:1263-1269.
25 +
Kouwenhoven WB, Jude JR, Knickerbocker GG.  Closed chest cardiac massage. JAMA . 1960;;173:1064-1067.
26 +
Lurie KG, Lindo C, Chin J.  CPR: the P stands for plumber's helper. JAMA . 1990;;264:1661.
27 +
Cohen TJ, Tucker KJ, Redberg RF, et al.  Active compression-decompression resuscitation: a new method of cardiopulmonary resuscitation. Circulation . 1991;;84:II-9.
28 +
American Heart Association.  Standards and guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC). JAMA . 1986;;255:2905-2973.
29 +
Fisher DC, Sahn DJ, Friedman MJ, et al.  The mitral valve orifice method for noninvasive two-dimensional echo Doppler determinations of cardiac output. Circulation . 1983;;67:872-877.
30 +
Lewis JF, Kuo LC, Nelson JG, et al.  Pulsed Doppler echocardiographic determination of stroke volume and cardiac output: clinical validation of two new methods using the apical window. Circulation . 1984;; 70:425-431.
31 +
Meijboom EJ, Horowitz S, Valdez-Cruz LM, et al.  A two-dimensional Doppler echocardiographic method for calculation of pulmonary and systemic blood flow in a canine model with variable-sized left-to-right extra-cardiac shunt. Circulation . 1983;;68:437.
32 +
Black IW, Hopkins AP, Lee LCL, Walsh WF, Jacobson BM.  Left atrial spontaneous echo contrast: a clinical and echocardiographic analysis. J Am Coll Cardiol . 1991;;18:398-404.
33 +
Goetting MG, Paradis NA, Appleton TJ, Rivers EP, Martin GB, Nowak RM.  Aortic-carotid artery pressure differences and cephalic perfusion pressure during cardiopulmonary resuscitation in humans. Crit Care Med . 1991;;19:1012-1017.
34 +
McDonald J L.  Systolic and mean arterial pressures during manual and mechanical CPR in humans. Ann Emerg Med . 1982;;11:292-295.
35 +
Callaham M, Barton C.  Prediction of outcome of cardiopulmonary resuscitation from end-tidal carbon dioxide concentration. Crit Care Med . 1990;;18:358-362.
36 +
Garnett AR, Ornato JP, Gonzalez ER, Johnson EB.  End-tidal carbon dioxide monitoring during cardiopulmonary resuscitation. JAMA . 1987;;257:512-515.
37 +
Sanders AB, Atlas M, Ewy GA, Kern KB, Bragg S.  Expired PCO2 as an index of coronary perfusion pressure. Am J Emerg Med . 1985;;3:147-149.
38 +
Trevino RP, Bisera J, Weil MH, Rackow EC, Grundler WG.  End-tidal CO2 as a guide to successful cardiopulmonary resuscitation: a preliminary report. Crit Care Med . 1985;;13:910-911.
39 +
Gudipati CV, Weil MH, Bisera UJ, Deshmukh HG, Rackow EC.  Expired carbon dioxide: a noninvasive monitor of cardiopulmonary resuscitation. Circulation . 1988;;77:234-239.
40 +
Sanders AB, Ewy GA, Bragg S, Atlas M, Kern KB.  Expired PCO2 as a prognostic indicator of successful resuscitation from cardiac arrest. Ann Emerg Med . 1985;;14:948-952.
41 +
Weil MH, Bisera J, Trevino RP, Rackow EC.  Cardiac output and end-tidal carbon dioxide. Crit Care Med . 1985;;13:907-909.
42 +
Sanders AB, Kern KB, Otto CW, Milander MM, Ewy GA.  End-tidal carbon dioxide monitoring during cardiopulmonary resuscitation: a prognostic indicator for survival. JAMA . 1989;;262:1347-1351.
43 +
Callaham M, Barton C, Maay M.  The effect of epinephrine on the ability of ETCO2 readings to predict initial resuscitation from cardiac arrest. Crit Care Med . In press.
44 +
Chandra NC, Tsitlik J E, Halperin HR, Guerci AD, Weisfeldt ML.  Observations of hemodynamics during human cardiopulmonary resuscitation. Crit Care Med . 1990;;18:929-934.
45 +
Martin GB, Carden DL, Nowak RM, Lewinter JR, Johnston W, Tomlanovich MC.  Aortic and right atrial pressures during standard and simultaneous compression and ventilation CPR in human beings. Ann Emerg Med . 1986;;15:125-130.
46 +
Ornato JP, Levine RL, Young DS, Racht EM, Garnett AR, Gonzalez ER.  The effect of applied chest compression force on systemic arterial pressure and end-tidal carbon dioxide concentration during CPR in human beings. Ann Emerg Med . 1989;;18:732-737.

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1 +
Eisenberg MS, Bergner L, Hallstrom A.  Cardiac resuscitation in the community: importance of rapid provision and implications for program planning. JAMA . 1979;;241:1905.
2 +
Eisenberg MS, Copass MK, Hallstrom AP, et al.  Treatment of out-of-hospital cardiac arrests with rapid defibrillation by emergency medical technicians. N Engl J Med . 1980;;302:1379-1383.
3 +
Eisenberg MS, Hallstrom A, Bergner L.  Long-term survival after out-of-hospital cardiac arrest. N Engl J Med . 1982;;306:1340-1343.
4 +
Peatfield RC, Sillett RW, Taylor D, McNichol MW.  Survival after cardiac arrest in hospital. Lancet . 1977;; 2:1223-1225.
5 +
Bedell SE, Delbanco TL, Cook EF, Epstein FH.  Survival after cardiopulmonary resuscitation in the hospital. N Engl J Med . 1983;;309:569-576.
6 +
Del Guercio LRM, Coomaraswamy RP, State D.  Cardiac output and other hemodynamic variables during external cardiac massage in man. N Engl J Med . 1963;;269:1398-1404.
7 +
Koehler RC, Chandra N, Guerci AD, et al.  Augmentation of cerebral perfusion by simultaneous chest compression and lung inflation with abdominal binding after cardiac arrest in dogs. Circulation . 1983;;67:266-275.
8 +
Walker JW, Bruestle JC, White BC, et al.  Perfusion of cerebral cortex by use of abdominal counterpulsation during cardiopulmonary resuscitation. Am J Emerg Med . 1984;;2:391-393.
9 +
Chandra N, Weisfeldt M, Tsitlik J, et al.  Augmentation of cardiac flow during cardiopulmonary resuscitation by ventilation at high airway pressure simultaneous with chest compression. Am J Cardiol . 1981;;48: 1053-1063.
10 +
Chandra NC, Beyar R, Halperin HR, et al.  Vital organ perfusion during assisted circulation by manipulation of intrathoracic pressure. Circulation . 1991;;84: 279-286.
11 +
Berryman CR, Phillips GM.  Interposed abdominal compression-CPR in human subjects. Ann Emerg Med . 1984;;13:226-229.
12 +
Kaplan BC, Civetta JM, Nagel EL, et al.  The military antishock trousers in civilian pre-hospital emergency care. J Trauma . 1973;;13:843-848.
13 +
Criley JM, Blaufuss AH, Kissel GL.  Cough-induced cardiac compression: self-administered form of cardiopulmonary resuscitation. JAMA . 1976;;236:1246-1250.
14 +
Sack J B, Kesselbrenner MB, Jarrad A, Bregman D.  Effect of interposed abdominal counterpulsation on resuscitation outcome during asystole and electromechanical dissociation. J Am Coll Cardiol . 1991;;17:179a.
15 +
Spalding JMK, Smith AC. Clinical Practice and Physiology of Artificial Respiration . Oxford, England: Blackwell Scientific Publications; 1963;.
16 +
Krischer JP, Fine EG, Weisfeldt ML, et al.  Comparison of prehospital conventional and simultaneous compression-ventilation cardiopulmonary resuscitation. Crit Care Med . 1989;;17:1263-1269.
17 +
Bircher N, Safar P.  Comparison of standard and 'new' closed-chest CPR and open-chest CPR in dogs. Crit Care Med . 1981;;9:384-385.
18 +
Niemann JT, Rosborough JP, Ung S, et al.  Hemodynamic effects of continuous abdominal binding during cardiac arrest and resuscitation. Am J Cardiol . 1984;;53:269-274.
19 +
Niemann JT, Rosborough JP, Niskanen RA, et al.  Mechanical 'cough' cardiopulmonary resuscitation during cardiac arrest in dogs. Am J Cardiol . 1985;;55:199-204.
20 +
Halperin HR, Guerci AD, Chandra N, et al.  Vest inflation without simultaneous ventilation during cardiac arrest in dogs: improved survival from prolonged cardiopulmonary resuscitation. Circulation . 1986;;74: 1407-1415.
21 +
Bircher N, Safar P, Stewart R.  A comparison of standard, MAST-augmented and open-chest CPR in dogs: a preliminary investigation. Crit Care Med . 1980;;8:147-152.
22 +
Berryman CR, Phillips GM.  Interposed abdominal compression-CPR in human subjects. Ann Emerg Med . 1984;;13:226-229.
23 +
Howard M, Carrubba C, Foss F, et al.  Interposed abdominal compression-CPR: its effects on parameters of coronary perfusion in human subjects. Ann Emerg Med . 1987;;16:253-259.
24 +
Krischer JP, Fine EG, Weisfeldt ML, Guerci AD, Nagel G, Chandra N.  Comparison of prehospital conventional and simultaneous compression-ventilation cardiopulmonary resuscitation. Crit Care Med . 1989;; 17:1263-1269.
25 +
Kouwenhoven WB, Jude JR, Knickerbocker GG.  Closed chest cardiac massage. JAMA . 1960;;173:1064-1067.
26 +
Lurie KG, Lindo C, Chin J.  CPR: the P stands for plumber's helper. JAMA . 1990;;264:1661.
27 +
Cohen TJ, Tucker KJ, Redberg RF, et al.  Active compression-decompression resuscitation: a new method of cardiopulmonary resuscitation. Circulation . 1991;;84:II-9.
28 +
American Heart Association.  Standards and guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC). JAMA . 1986;;255:2905-2973.
29 +
Fisher DC, Sahn DJ, Friedman MJ, et al.  The mitral valve orifice method for noninvasive two-dimensional echo Doppler determinations of cardiac output. Circulation . 1983;;67:872-877.
30 +
Lewis JF, Kuo LC, Nelson JG, et al.  Pulsed Doppler echocardiographic determination of stroke volume and cardiac output: clinical validation of two new methods using the apical window. Circulation . 1984;; 70:425-431.
31 +
Meijboom EJ, Horowitz S, Valdez-Cruz LM, et al.  A two-dimensional Doppler echocardiographic method for calculation of pulmonary and systemic blood flow in a canine model with variable-sized left-to-right extra-cardiac shunt. Circulation . 1983;;68:437.
32 +
Black IW, Hopkins AP, Lee LCL, Walsh WF, Jacobson BM.  Left atrial spontaneous echo contrast: a clinical and echocardiographic analysis. J Am Coll Cardiol . 1991;;18:398-404.
33 +
Goetting MG, Paradis NA, Appleton TJ, Rivers EP, Martin GB, Nowak RM.  Aortic-carotid artery pressure differences and cephalic perfusion pressure during cardiopulmonary resuscitation in humans. Crit Care Med . 1991;;19:1012-1017.
34 +
McDonald J L.  Systolic and mean arterial pressures during manual and mechanical CPR in humans. Ann Emerg Med . 1982;;11:292-295.
35 +
Callaham M, Barton C.  Prediction of outcome of cardiopulmonary resuscitation from end-tidal carbon dioxide concentration. Crit Care Med . 1990;;18:358-362.
36 +
Garnett AR, Ornato JP, Gonzalez ER, Johnson EB.  End-tidal carbon dioxide monitoring during cardiopulmonary resuscitation. JAMA . 1987;;257:512-515.
37 +
Sanders AB, Atlas M, Ewy GA, Kern KB, Bragg S.  Expired PCO2 as an index of coronary perfusion pressure. Am J Emerg Med . 1985;;3:147-149.
38 +
Trevino RP, Bisera J, Weil MH, Rackow EC, Grundler WG.  End-tidal CO2 as a guide to successful cardiopulmonary resuscitation: a preliminary report. Crit Care Med . 1985;;13:910-911.
39 +
Gudipati CV, Weil MH, Bisera UJ, Deshmukh HG, Rackow EC.  Expired carbon dioxide: a noninvasive monitor of cardiopulmonary resuscitation. Circulation . 1988;;77:234-239.
40 +
Sanders AB, Ewy GA, Bragg S, Atlas M, Kern KB.  Expired PCO2 as a prognostic indicator of successful resuscitation from cardiac arrest. Ann Emerg Med . 1985;;14:948-952.
41 +
Weil MH, Bisera J, Trevino RP, Rackow EC.  Cardiac output and end-tidal carbon dioxide. Crit Care Med . 1985;;13:907-909.
42 +
Sanders AB, Kern KB, Otto CW, Milander MM, Ewy GA.  End-tidal carbon dioxide monitoring during cardiopulmonary resuscitation: a prognostic indicator for survival. JAMA . 1989;;262:1347-1351.
43 +
Callaham M, Barton C, Maay M.  The effect of epinephrine on the ability of ETCO2 readings to predict initial resuscitation from cardiac arrest. Crit Care Med . In press.
44 +
Chandra NC, Tsitlik J E, Halperin HR, Guerci AD, Weisfeldt ML.  Observations of hemodynamics during human cardiopulmonary resuscitation. Crit Care Med . 1990;;18:929-934.
45 +
Martin GB, Carden DL, Nowak RM, Lewinter JR, Johnston W, Tomlanovich MC.  Aortic and right atrial pressures during standard and simultaneous compression and ventilation CPR in human beings. Ann Emerg Med . 1986;;15:125-130.
46 +
Ornato JP, Levine RL, Young DS, Racht EM, Garnett AR, Gonzalez ER.  The effect of applied chest compression force on systemic arterial pressure and end-tidal carbon dioxide concentration during CPR in human beings. Ann Emerg Med . 1989;;18:732-737.

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