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May 11, 1994, Vol 271, No. 18 >
ARTICLE | May 11, 1994

Evaluation of Active Compression-Decompression CPR in Victims of Out-of-Hospital Cardiac Arrest FREE

Keith G. Lurie, MD; Jeffrey J. Shultz, MD; Michael L. Callaham, MD; Theresa M. Schwab, MD; Terry Gisch, EMT-P; Thomas Rector, PhD; Ralph J. Frascone, MD; Linda Long, MD
[+] Author Affiliations

Reprint requests to 508 University of Minnesota Hospitals and Clinic, 420 Delaware St SE, Minneapolis, MN 55455 (Dr Lurie).


JAMA. 1994;271(18):1405-1411. doi:10.1001/jama.1994.03510420037031
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References

Objective.  —Active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) appears to improve ventilation and coronary perfusion when compared with standard CPR. The objective was to evaluate potential benefits of this new CPR technique in patients with out-of-hospital cardiac arrest in St Paul, Minn.

Design.  —Ten-month, prospective, randomized parallel-group design.

Setting.  —St Paul, Minn, population 270000.

Patients.  —All normothermic victims of nontraumatic cardiac arrest older than 8 years who received CPR.

Main Outcome Measures.  —Return of spontaneous circulation, admission to the intensive care unit (ICU), return of baseline neurological function (alert and oriented to person, place, and time), survival to hospital discharge, survival to hospital discharge with return of baseline neurological function, and complications.

Results.  —Seventy-seven patients received standard CPR and 53 patients received ACD CPR. The mean emergency medical services call response interval was less than 3.5 minutes. When all patients were considered, a higher percentage of ACD CPR patients had a return of spontaneous circulation and were admitted to the ICU vs standard CPR (45% vs 31%, and 40% vs 26%, respectively), but these trends were not statistically significant (P<.10 and P<.10). No statistically significant differences were found between hospital discharge rates (12[23%] of 53 for ACD CPR vs 13 [17%] of 77 for standard CPR), return to baseline neurological function (10 [19%] of 53 for ACD CPR vs 13 [17%] of 77 for standard CPR), or return to baseline neurological function at hospital discharge (nine [17%] of 53 for ACD CPR vs 12 [16%] of 77 for standard CPR). Return of spontaneous circulation, ICU admission, and neurological recovery in both CPR groups were highly correlated with downtime (time from collapse to emergency medical system personnel arrival to the scene in witnessed arrests). With less than 10 minutes' downtime, survival to the ICU was 59% (19/32) with ACD CPR and 33% (16/49) with standard CPR (P<.02), return to baseline neurological function was 31% (10/32) with ACD CPR and 20% (10/49) with standard CPR (P=.27), and hospital discharge rate was 38% (12/32) with ACD CPR and 20% (10/49) with standard CPR (P=.17). Complication rates in patients admitted to the hospital were similar in both groups.

Conclusions.  —This study demonstrates that ACD CPR appears to be more effective than standard CPR in a well-defined subset of victims of out-of-hospital cardiac arrest during the critical early phases of resuscitation. Based on this study, a larger study should be performed to evaluate the potential long-term benefits of ACD CPR.(JAMA. 1994;271:1405-1411)

REFERENCES

1 +
Emergency Cardiac Care Committee and Subcommittees, American Heart Association.  Guidelines for cardiopulmonary resuscitation and emergency cardiac care. JAMA . 1992;;268:2171-2298.
2 +
Becker LB, Smith DW, Rhodes RV.  Incidence of cardiac arrest: a neglected factor in evaluating survival rates. Ann Emerg Med . 1993;;22:86-91.
3 +
Lurie KG, Lindo C, Chin J.  CPR: the P stands for plumber's helper. JAMA . 1990;;264:1661.
4 +
Cohen TJ, Tucker KJ, Lurie KG, et al.  Active compression-decompression: a new method of cardiopulmonary resuscitation. JAMA . 1992;;267:2916-2923.
5 +
Shultz JJ, Coffeen P, Sweeney M, et al.  Evaluation of standard and active compression-decompression CPR in an acute human model of ventricular fibrillation. Circulation . 1994;;89:684-693.
6 +
Chang MW, Coffeen P, Lurie KG, Shultz JJ, Bache RJ, White CW.  Tissue perfusion during standard vs active compression decompression CPR in the dog. Chest . In press.
7 +
Lindner K, Pfenninger E, Lurie KG, Schurmann W, Lindner I.  Effects of active compression-decompression resuscitation on myocardial and cerebral blood flow in pigs. Circulation . 1993;;88:1254-1263.
8 +
Rivers EP, Boczar ME, Smithline HA, Lurie KG, Nowak RM.  A Comparison of mechanical, standard and active compression-decompression CPR in out-of-hospital cardiac arrest patients. Circulation . 1993;;88:I-193.
9 +
Cummins RO, Chamberlain DA, Abramson NS, et al.  Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein style. Ann Emerg Med . 1991;;20:861-874.
10 +
Simon R.  Confidence intervals for reporting results of clinical trials. Ann Intern Med . 1986;;105: 429-435.
11 +
Eisenberg MS, Bergner L, Hallstrom A.  Cardiac resuscitation in the community: importance of rapid provision and implications for program planning. JAMA . 1979;;241:1905-1907.
12 +
Kouwenhoven WB,Jude JR, Knickerbocker GG.  Closed-chest cardiac massage. JAMA . 1960;;173: 1064-1067.
13 +
Mateer JR, Stueven HA, Thompson BM, Aprahamian C, Darin JC.  Pre-hospital IAC-CPR versus standard CPR: paramedic resuscitation of cardiac arrests. Am J Emerg Med . 1985;;3:143-146.
14 +
Brown CG, Martin DR, Pepe PE, et al.  Comparison of standard-dose and high-dose epinephrine in cardiac arrest outside the hospital. N Engl J Med . 1992;;327:1051-1055.
15 +
Cohen TJ, Goldner BG, Maccaro PC, et al.  A comparison of active compression-decompression cardiopulmonary resuscitation with standard cardiopulmonary resuscitation for cardiac arrests occurring in the hospital. N Engl J Med . 1993;;329: 1918-1921.
16 +
Tucker KJ, Galli F, Savitt MA, Kahsai D, Bresnahan L, Redberg RF.  Active compression-decompression resuscitation: effects on resuscitation success after in-hospital arrest. Circulation . 1993;;88: I-10.
17 +
Malzer R, Knappitsch G, Donanovits H, Sterz F.  Active decompression during external cardiac massage: will the rescue breathing become superfluous? Intensivmedizin Notfallmedizin . 1993;;30: 260-261.

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1 +
Emergency Cardiac Care Committee and Subcommittees, American Heart Association.  Guidelines for cardiopulmonary resuscitation and emergency cardiac care. JAMA . 1992;;268:2171-2298.
2 +
Becker LB, Smith DW, Rhodes RV.  Incidence of cardiac arrest: a neglected factor in evaluating survival rates. Ann Emerg Med . 1993;;22:86-91.
3 +
Lurie KG, Lindo C, Chin J.  CPR: the P stands for plumber's helper. JAMA . 1990;;264:1661.
4 +
Cohen TJ, Tucker KJ, Lurie KG, et al.  Active compression-decompression: a new method of cardiopulmonary resuscitation. JAMA . 1992;;267:2916-2923.
5 +
Shultz JJ, Coffeen P, Sweeney M, et al.  Evaluation of standard and active compression-decompression CPR in an acute human model of ventricular fibrillation. Circulation . 1994;;89:684-693.
6 +
Chang MW, Coffeen P, Lurie KG, Shultz JJ, Bache RJ, White CW.  Tissue perfusion during standard vs active compression decompression CPR in the dog. Chest . In press.
7 +
Lindner K, Pfenninger E, Lurie KG, Schurmann W, Lindner I.  Effects of active compression-decompression resuscitation on myocardial and cerebral blood flow in pigs. Circulation . 1993;;88:1254-1263.
8 +
Rivers EP, Boczar ME, Smithline HA, Lurie KG, Nowak RM.  A Comparison of mechanical, standard and active compression-decompression CPR in out-of-hospital cardiac arrest patients. Circulation . 1993;;88:I-193.
9 +
Cummins RO, Chamberlain DA, Abramson NS, et al.  Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein style. Ann Emerg Med . 1991;;20:861-874.
10 +
Simon R.  Confidence intervals for reporting results of clinical trials. Ann Intern Med . 1986;;105: 429-435.
11 +
Eisenberg MS, Bergner L, Hallstrom A.  Cardiac resuscitation in the community: importance of rapid provision and implications for program planning. JAMA . 1979;;241:1905-1907.
12 +
Kouwenhoven WB,Jude JR, Knickerbocker GG.  Closed-chest cardiac massage. JAMA . 1960;;173: 1064-1067.
13 +
Mateer JR, Stueven HA, Thompson BM, Aprahamian C, Darin JC.  Pre-hospital IAC-CPR versus standard CPR: paramedic resuscitation of cardiac arrests. Am J Emerg Med . 1985;;3:143-146.
14 +
Brown CG, Martin DR, Pepe PE, et al.  Comparison of standard-dose and high-dose epinephrine in cardiac arrest outside the hospital. N Engl J Med . 1992;;327:1051-1055.
15 +
Cohen TJ, Goldner BG, Maccaro PC, et al.  A comparison of active compression-decompression cardiopulmonary resuscitation with standard cardiopulmonary resuscitation for cardiac arrests occurring in the hospital. N Engl J Med . 1993;;329: 1918-1921.
16 +
Tucker KJ, Galli F, Savitt MA, Kahsai D, Bresnahan L, Redberg RF.  Active compression-decompression resuscitation: effects on resuscitation success after in-hospital arrest. Circulation . 1993;;88: I-10.
17 +
Malzer R, Knappitsch G, Donanovits H, Sterz F.  Active decompression during external cardiac massage: will the rescue breathing become superfluous? Intensivmedizin Notfallmedizin . 1993;;30: 260-261.

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