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April 26, 1995, Vol 273, No. 16 >
ARTICLE | April 26, 1995

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

Theresa M. Schwab, MD; Michael L. Callaham, MD; Christopher D. Madsen; Thomas A. Utecht, MD
[+] Author Affiliations

Reprint requests to Department of Emergency Medicine, University of California, San Francisco, San Joaquin Medical Education Program at Valley Medical Center, Fresno, CA 93702 (Dr Schwab).


JAMA. 1995;273(16):1261-1268. doi:10.1001/jama.1995.03520400031040
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References

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)

REFERENCES

1 +
Emergency Cardiac Care Committee and Subcommittees, American Heart Association.  Guidelines for cardiopulmonary resuscitation and emergency cardiac care, I: introduction. JAMA . 1992;; 268:2171-2183.
2 +
Becker LB, Smith DW, Rhodes KV.  Incidence of cardiac arrest: a neglected factor in evaluating survival rates. Ann Emerg Med . 1993;;22:86-91.
3 +
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.
4 +
Sanders AB, Meislin HW, Ewy GA.  The physiology of cardiopulmonary resuscitation: an update. JAMA . 1984;;252:3283-3286.
5 +
Lurie KG, Lindo C, Chin J.  CPR: the P stands for plumber's helper. JAMA . 1990;;264:1661.
6 +
Cohen TJ, Tucker RT, Redberg RF, et al.  Active compression-decompression resuscitation: a novel method of cardiopulmonary resuscitation. Am Heart J . 1992;;124:1145-1150.
7 +
Cohen TJ, Tucker KJ, Lurie KG, et al.  Active compression-decompression: a new method of cardiopulmonary resuscitation. JAMA 1992;;267:2916-2923.
8 +
Tucker KJ, Redberg RF, Schiller NB, et al.  Active compression-decompression resuscitation: analysis of transmitral flow and left ventricular volume by transesophageal echocardiography in humans. J Am Coll Cardiol . 1993;;22:1485-1493.
9 +
Shultz JJ, Coffeen P, Sweeney M, et al.  Evaluation of standard and active compression decompression CPR in an acute model of ventricular fibrillation. Circulation . 1994;;89:684-693.
10 +
Chang MW, Coffeen P, Lurie KG, et al.  Tissue perfusion during standard vs active compression decompression CPR in the dog. Circulation . 1992;; 86:I-233. Abstract.
11 +
Lindner KH, Pfenninger EG, Lurie KG, et al.  Effects of active compression-decompression resuscitation on myocardial and cerebral blood flow in pigs. Circulation . 1993;;88:1254-1263.
12 +
Cohen TJ, Goldner BG, Maccaro PC, et al.  A comparison of active compression-decompression cardiopulmonary resuscitation with standard cardiopulmonary resuscitation for cardiac arrests occuring in the hospital. N Engl J Med . 1993;;329: 1918-1921.
13 +
Tucker KJ, Galli F, Savitt MA, et al.  Active compression-decompression resuscitation: effect on resuscitation success after in-hospital cardiac arrest. J Am Coll Cardiol . 1994;;24:201-209.
14 +
Lurie KG, Shultz J, Callaham ML, et al.  Evaluation of active compression-decompression CPR in victims of out-of-hospital cardiac arrest. JAMA . 1994;;271:1405-1411.
15 +
Emergency Cardiac Care Committee and Subcommittees, American Heart Association.  Guidelines for cardiopulmonary resuscitation and emergency cardiac care, III: adult advanced cardiac life support. JAMA . 1992;;268:2199-2241.
16 +
Emergency Cardiac Care Committee and Subcommittees, American Heart Association.  Guidelines for cardiopulmonary resuscitation and emergency cardiac care, II: adult basic life support. JAMA . 1992;;268:2184-2198.
17 +
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.
18 +
Brain Resuscitation Trial Group.  A randomized clinical study of cardiopulmonary-cerebral resuscitation. Am J Emerg Med . 1986;;4:72-86.
19 +
Callaham M, Barton C.  Prediction of outcome of cardiopulmonary resuscitation from end-tidal carbon dioxide concentration. Crit Care Med . 1990;;18: 358-362.
20 +
Lombardi G, Gallagher J, Gennis P.  Outcome of out-of-hospital cardiac arrest in New York City: the Pre-Hospital Arrest Survival Evaluation (PHASE) study. JAMA . 1994;;271:678-683.
21 +
Cowie MR, Fahrenbruch CE, Cobb LA, et al.  Out-of-hospital cardiac arrest: racial differences in outcome in Seattle. Am J Public Health . 1993;;83: 955-959.
22 +
Becker LB, Han BH, Meyer PM, et al.  Racial differences in the incidence of cardiac arrest and subsequent survival: the CPR Chicago Project. N Engl J Med . 1993;;329:600-606.
23 +
Hallstrom A, Boutin P, Cobb L, et al.  Socioeconomic status and prediction of ventricular fibrillation survival. Am J Public Health . 1993;;83: 245-248.
24 +
Cordell WH, Olinger ML, Kozak PA, Nyhuis AW.  Does anybody really know what time it is? does anybody really care? Ann Emerg Med . 1994;; 23:1032-1036.
25 +
Cummins RO, Theis W.  Encouraging early defibrillation: the American Heart Association and automated external defibrillators. Ann Emerg Med . 1990;;19:1245-1248.
26 +
Eisenberg MS, Cummins RO.  Defibrillation performed by the emergency medical technician. Circulation . 1986;;74( (suppl) ):IV9-IV12.
27 +
Chandra N, Rudekoff M, Weisfeldt ML.  Simultaneous chest compression and ventilation at high airway pressure during cardiopulmonary resuscitation. Lancet . 1980;;1:175-178.
28 +
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.
29 +
Berryman CR, Phillips GM.  Interposed abdominal compression-CPR in human subjects. Ann Emerg Med . 1984;;13:226-229.
30 +
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.
31 +
Mateer JR, Stueven HA, Thompson BM.  Prehospital IAC-CPR vs standard CPR: paramedic resuscitation of cardiac arrests. Am J Emerg Med . 1985;;3:143-146.
32 +
Lindner KH, Ahnefeld FW, Bowdler IM.  Cardiopulmonary resuscitation with interposed abdominal compression after asphyxial or fibrillatory cardiac arrest in pigs. Anesthesiology . 1990;; 72:675-681.
33 +
Sack JB, Kesselbrenner MB, Jarrad A.  Interposed abdominal compression-cardiopulmonary resuscitation and resuscitation outcome during asystole and electromechanical dissociation. Circulation . 1992;;86:1692-1700.
34 +
Kern KB, Ewy GA.  Minimal coronary stenoses and left ventricular blood flow during CPR. Ann Emerg Med . 1992;;21:1066-1072.

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1 +
Emergency Cardiac Care Committee and Subcommittees, American Heart Association.  Guidelines for cardiopulmonary resuscitation and emergency cardiac care, I: introduction. JAMA . 1992;; 268:2171-2183.
2 +
Becker LB, Smith DW, Rhodes KV.  Incidence of cardiac arrest: a neglected factor in evaluating survival rates. Ann Emerg Med . 1993;;22:86-91.
3 +
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.
4 +
Sanders AB, Meislin HW, Ewy GA.  The physiology of cardiopulmonary resuscitation: an update. JAMA . 1984;;252:3283-3286.
5 +
Lurie KG, Lindo C, Chin J.  CPR: the P stands for plumber's helper. JAMA . 1990;;264:1661.
6 +
Cohen TJ, Tucker RT, Redberg RF, et al.  Active compression-decompression resuscitation: a novel method of cardiopulmonary resuscitation. Am Heart J . 1992;;124:1145-1150.
7 +
Cohen TJ, Tucker KJ, Lurie KG, et al.  Active compression-decompression: a new method of cardiopulmonary resuscitation. JAMA 1992;;267:2916-2923.
8 +
Tucker KJ, Redberg RF, Schiller NB, et al.  Active compression-decompression resuscitation: analysis of transmitral flow and left ventricular volume by transesophageal echocardiography in humans. J Am Coll Cardiol . 1993;;22:1485-1493.
9 +
Shultz JJ, Coffeen P, Sweeney M, et al.  Evaluation of standard and active compression decompression CPR in an acute model of ventricular fibrillation. Circulation . 1994;;89:684-693.
10 +
Chang MW, Coffeen P, Lurie KG, et al.  Tissue perfusion during standard vs active compression decompression CPR in the dog. Circulation . 1992;; 86:I-233. Abstract.
11 +
Lindner KH, Pfenninger EG, Lurie KG, et al.  Effects of active compression-decompression resuscitation on myocardial and cerebral blood flow in pigs. Circulation . 1993;;88:1254-1263.
12 +
Cohen TJ, Goldner BG, Maccaro PC, et al.  A comparison of active compression-decompression cardiopulmonary resuscitation with standard cardiopulmonary resuscitation for cardiac arrests occuring in the hospital. N Engl J Med . 1993;;329: 1918-1921.
13 +
Tucker KJ, Galli F, Savitt MA, et al.  Active compression-decompression resuscitation: effect on resuscitation success after in-hospital cardiac arrest. J Am Coll Cardiol . 1994;;24:201-209.
14 +
Lurie KG, Shultz J, Callaham ML, et al.  Evaluation of active compression-decompression CPR in victims of out-of-hospital cardiac arrest. JAMA . 1994;;271:1405-1411.
15 +
Emergency Cardiac Care Committee and Subcommittees, American Heart Association.  Guidelines for cardiopulmonary resuscitation and emergency cardiac care, III: adult advanced cardiac life support. JAMA . 1992;;268:2199-2241.
16 +
Emergency Cardiac Care Committee and Subcommittees, American Heart Association.  Guidelines for cardiopulmonary resuscitation and emergency cardiac care, II: adult basic life support. JAMA . 1992;;268:2184-2198.
17 +
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.
18 +
Brain Resuscitation Trial Group.  A randomized clinical study of cardiopulmonary-cerebral resuscitation. Am J Emerg Med . 1986;;4:72-86.
19 +
Callaham M, Barton C.  Prediction of outcome of cardiopulmonary resuscitation from end-tidal carbon dioxide concentration. Crit Care Med . 1990;;18: 358-362.
20 +
Lombardi G, Gallagher J, Gennis P.  Outcome of out-of-hospital cardiac arrest in New York City: the Pre-Hospital Arrest Survival Evaluation (PHASE) study. JAMA . 1994;;271:678-683.
21 +
Cowie MR, Fahrenbruch CE, Cobb LA, et al.  Out-of-hospital cardiac arrest: racial differences in outcome in Seattle. Am J Public Health . 1993;;83: 955-959.
22 +
Becker LB, Han BH, Meyer PM, et al.  Racial differences in the incidence of cardiac arrest and subsequent survival: the CPR Chicago Project. N Engl J Med . 1993;;329:600-606.
23 +
Hallstrom A, Boutin P, Cobb L, et al.  Socioeconomic status and prediction of ventricular fibrillation survival. Am J Public Health . 1993;;83: 245-248.
24 +
Cordell WH, Olinger ML, Kozak PA, Nyhuis AW.  Does anybody really know what time it is? does anybody really care? Ann Emerg Med . 1994;; 23:1032-1036.
25 +
Cummins RO, Theis W.  Encouraging early defibrillation: the American Heart Association and automated external defibrillators. Ann Emerg Med . 1990;;19:1245-1248.
26 +
Eisenberg MS, Cummins RO.  Defibrillation performed by the emergency medical technician. Circulation . 1986;;74( (suppl) ):IV9-IV12.
27 +
Chandra N, Rudekoff M, Weisfeldt ML.  Simultaneous chest compression and ventilation at high airway pressure during cardiopulmonary resuscitation. Lancet . 1980;;1:175-178.
28 +
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.
29 +
Berryman CR, Phillips GM.  Interposed abdominal compression-CPR in human subjects. Ann Emerg Med . 1984;;13:226-229.
30 +
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.
31 +
Mateer JR, Stueven HA, Thompson BM.  Prehospital IAC-CPR vs standard CPR: paramedic resuscitation of cardiac arrests. Am J Emerg Med . 1985;;3:143-146.
32 +
Lindner KH, Ahnefeld FW, Bowdler IM.  Cardiopulmonary resuscitation with interposed abdominal compression after asphyxial or fibrillatory cardiac arrest in pigs. Anesthesiology . 1990;; 72:675-681.
33 +
Sack JB, Kesselbrenner MB, Jarrad A.  Interposed abdominal compression-cardiopulmonary resuscitation and resuscitation outcome during asystole and electromechanical dissociation. Circulation . 1992;;86:1692-1700.
34 +
Kern KB, Ewy GA.  Minimal coronary stenoses and left ventricular blood flow during CPR. Ann Emerg Med . 1992;;21:1066-1072.

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