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May 8, 1996, Vol 275, No. 18 >
ARTICLE | May 8, 1996

The Ontario Trial of Active Compression-Decompression Cardiopulmonary Resuscitation for In-Hospital and Prehospital Cardiac Arrest FREE

Ian G. Stiell, MD, MSc, FRCPC; Paul C. Hébert, MD, MHSc, FRCPC; George A. Wells, PhD; Andreas Laupacis, MD, MSc, FRCPC; Katherine Vandemheen, BScN; Jonathan F. Dreyer, MD, FRCPC; Mary A. Eisenhauer, MD, FRCPC; John Gibson, MD, FRCPC; Lyall A. J. Higginson, MD, FRCPC; Ann S. Kirby, MD, FRCPC; Jeffrey L. Mahon, MD, FRCPC; Justin P. Maloney, MD, FRCPC; Brian N. Weitzman, MD, FRCPC
[+] Author Affiliations

Reprints: Ian G. Stiell, MD, MSc, FRCPC, Clinical Epidemiology Unit, Loeb Medical Research Institute, Ottawa Civic Hospital, 1053 Carling Ave, Ottawa, Ontario, Canada K1Y 4E9.


JAMA. 1996;275(18):1417-1423. doi:10.1001/jama.1996.03530420045034
Text Size: A A A
Published online
Article
References

Objective.  —To compare the impact of active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) and standard CPR on the outcomes of in-hospital and prehospital victims of cardiac arrest.

Design.  —Randomized controlled trial with blinding of allocation using a sealed container.

Settings.  —(1) Emergency departments, wards, and intensive care units of 5 university hospitals and (2) all locations outside hospitals in 2 midsized cities.

Patients.  —A total of 1784 adults who had cardiac arrest.

Intervention.  —Patients received either standard or ACD CPR throughout resuscitation.

Main Outcome Measures.  —Survival for 1 hour and to hospital discharge and the modified Mini—Mental State Examination (MMSE).

Results.  —All characteristics were similar in the standard and ACD CPR groups for the 773 in-hospital patients and the 1011 prehospital patients. For in-hospital patients, there were no significant differences between the standard (n=368) and ACD (n=405) CPR groups in survival for 1 hour (35.1% vs 34.6%; P=.89), in survival until hospital discharge (11.4% vs 10.4%; P=.64), or in the median MMSE score of survivors (37 in both groups). For patients who collapsed outside the hospital, there were also no significant differences between the standard (n=510) and ACD (n=501) CPR groups in survival for 1 hour (16.5% vs 18.2%; P=.48), in survival to hospital discharge (3.7% vs 4.6%; P=.49), or in the median MMSE score of survivors (35 in both groups). Exploration of clinically important subgroups failed to identify any patients who appeared to benefit from ACD CPR.

Conclusions.  —ACD CPR did not improve survival or neurologic outcomes in any group of patients with cardiac arrest.(JAMA. 1996;275:1417-1423)

REFERENCES

1 +
Kouwenhoven WB, Jude JR, Knickerbocker GG.  Closed-chest cardiac massage. JAMA . 1960;;173: 1064-1067.
2 +
Emergency Cardiac Care Committee and Subcommittees, American Heart Association.  Guidelines for cardiopulmonary resuscitation and emergency cardiac care. JAMA . 1992;;268(theme issue): 2171-2298.
3 +
Niemann JT.  Cardiopulmonary resuscitation. N Engl J Med . 1992;;327:1075-1080.
4 +
Stiell IG, Wells GA, Hébert PC, Laupacis A, Weitzman BN.  Association of drug therapy with survival in cardiac arrest: limited role of advanced cardiac life support drugs. Acad Emerg Med . 1995;; 2:264-273.
5 +
Halperin HR, Weisfeldt ML.  New approaches to CPR: four hands, a plunger, or a vest. JAMA . 1992;; 267:2940-2941.
6 +
Sack JB, Kesselbrenner MB, Bregman D.  Survival from in-hospital cardiac arrest with interposed abdominal counterpulsation during cardiopulmonary resuscitation. JAMA . 1992;;267:379-385.
7 +
Halperin HR, Tsitlik JE, Gelfand M, et al.  A preliminary study of cardiopulmonary resuscitation by circumferential compression of the chest with use of a pneumatic vest. N Engl J Med . 1993;; 329:762-768.
8 +
Lurie KG, Lindo C, Chin J.  CPR: the P stands for plumber's helper. JAMA . 1990;;264:1661.
9 +
Lurie KG.  Active compression-decompression CPR: a progress report. Resuscitation . 1994;;28: 115-122.
10 +
Cohen TJ, Tucker KJ, Redberg RF, et al.  Active compression-decompression resuscitation: a novel method of cardiopulmonary resuscitation. Am Heart J . 1992;;124:1145-1150.
11 +
Lindner KH, Pfenninger EG, Lurie KG, Schuermann W, Lindner IM, Ahnefeld FW.  Effects of active compression-decompression resuscitation on myocardial and cerebral blood flow in pigs. Circulation . 1993;;88:1254-1263.
12 +
Tucker KJ, Khan JH, Savitt MA.  Active compression-decompression resuscitation: effects on pulmonary ventilation. Resuscitation . 1993;;26:125-131.
13 +
Chang MW, Coffeen P, Lurie KG, et al.  Augmentation of late diastolic coronary flow velocity: the mechanism of improved myocardial perfusion during active compression-decompression cardiopulmonary resuscitation? Circulation . 1993;;88:I-193.
14 +
Chang MW, Coffeen P, Lurie KG, Shultz JJ, Bache RJ, White CW.  Active compression-decompression CPR improves vital organ perfusion in a dog model of ventricular fibrillation. Chest . 1994;; 106:1250-1259.
15 +
Idris AH, Wenzel V, Tucker KJ, Orban DJ.  Chest compression ventilation: a comparison of standard CPR and active-compression/decompression CPR. Acad Emerg Med . 1994;;1:A17-A18.
16 +
Carli PA, De La Coussaye JE, Riou B, Sassine A, Eledjam JJ.  Ventilatory effects of active compression-decompression in dogs. Ann Emerg Med . 1994;;24:890-894.
17 +
Tucker KJ, Khan J, Idris A, Savitt MA.  The biphasic mechanism of blood flow during cardiopulmonary resuscitation: a physiologic comparison of active compression-decompression and high-impulse manual external cardiac massage. Ann Emerg Med . 1994;;24:895-906.
18 +
Wik L, Naess PA, Ilebekk A, Steen PA.  Simultaneous active compression-decompression and abdominal binding increase carotid blood flow additively during cardiopulmonary resuscitation (CPR) in pigs. Resuscitation . 1994;;28:55-64.
19 +
Cohen TJ, Tucker KJ, Lurie KG, et al.  Active compression-decompression: a new method of cardiopulmonary resuscitation. JAMA . 1992;;267:2916-2923.
20 +
Tucker KJ, Redberg RF, Schiller NB, Cohen TJ.  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.
21 +
Guly UM, Robertson CE.  Does active decompression improve the haemodynamic state during CPR? Resuscitation . 1994;;28:S27.
22 +
Malzer R, Knappitsch G, Zeiner A, Sterz F, Laggner AN.  Active compression-decompression resuscitation: effects on hemodynamics and pulmonary ventilation in 20 patients. Resuscitation . 1994;; 28:S5.
23 +
Rivers EP, McGeorge FT, Martin GB, et al.  Hemodynamic comparison of mechanical, standard, and active compression-decompression CPR in human cardiac arrest. Acad Emerg Med . 1994;;1:A19-A20.
24 +
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.
25 +
Orliaguet GA, Carli PA, Rozenberg A, Janniere D, Sauval P, Delpech P.  End-tidal carbon dioxide during out-of-hospital cardiac arrest resuscitation: comparison of active compression-decompression and standard CPR. Ann Emerg Med . 1995;; 25:48-51.
26 +
Lurie KG, Shultz JJ, Callaham ML, et al.  Evaluation of active compression-decompression CPR in victims of out-of-hospital cardiac arrest. JAMA . 1994;;271:1405-1411.
27 +
Schwab TM, Callaham ML, Madsen CD, Utecht TA.  A randomized clinical trial of active compression-decompression CPR vs standard CPR in out-of-hospital cardiac arrest in two cities. JAMA . 1995;; 273:1261-1268.
28 +
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.
29 +
Tucker KJ, Galli F, Savitt MA, Kahsai D, Bresnahan L, Redberg RF.  Active compression-decompression resuscitation: effect on resuscitation success after in-hospital cardiac arrest. J Am Coll Cardiol . 1994;;24:201-209.
30 +
Teng EL, Chui HC.  The Modified Mini-Mental State (3MS) Examination. J Clin Psychiatry . 1987;; 48:314-318.
31 +
The Brain Resuscitation Clinical Trial II Study Group.  A randomized clinical trial of calcium entry blocker administration to comatose survivors of cardiac arrest: design, methods, and patient characteristics. Control Clin Trials . 1991;;12:525-545.
32 +
O'Brien PC, Fleming TR.  A multiple testing procedure for clinical trials. Biometrics . 1979;;35: 549-556.
33 +
Zar JH. Biostatistical Analysis . Englewood Cliffs, NJ: Prentice-Hall Inc; 1984;.
34 +
Fleiss JL. The Design and Analysis of Clinical Experiments . New York, NY: John Wiley & Sons Inc; 1986;.
35 +
Hosmer DW, Lemeshow S. Applied Logistic Regression . New York, NY: John Wiley & Sons Inc; 1989;.
36 +
Rudikoff MT, Maughan WL, Effron M, Freund P, Weisfeldt ML.  Mechanisms of blood flow during cardiopulmonary resuscitation. Circulation . 1980;; 61:345-352.
37 +
Chandra N, Weisfeldt ML, Tsitlik J, et al.  Augmentation of carotid flow during cardiopulmonary resuscitation by ventilation at high airway pressure simultaneous with chest compression. Am J Cardiol . 1981;;48:1053-1063.
38 +
Tucker KJ, Idris A.  Clinical and laboratory investigations of active compression-decompression cardiopulmonary resuscitation. Resuscitation . 1994;; 28:1-7.
39 +
Pell ACH, Pringle SD, Guly UM, Steedman DJ, Robertson CE.  Assessment of the active compression-decompression device (ACD) in cardiopulmonary resuscitation using transoesophageal echocardiography. Resuscitation . 1994;;27:137-140.
40 +
Kosnik JW, Jackson RE, Keats S, Tworek RM, Freeman SB.  Dose-related response of centrally administered epinephrine on the change in aortic diastolic pressure during closed-chest massage in dogs. Ann Emerg Med . 1985;;14:204-208.
41 +
Brown CG, Werman HA, Davis EA, Hobson J, Hamlin RL.  The effects of graded doses of epinephrine on regional myocardial blood flow during cardiopulmonary resuscitation in swine. Circulation . 1987;;75:491-497.
42 +
Brown CG, Werman HA, Davis EA, Hamlin R, Hobson J, Ashton JA.  Comparative effects of graded doses of epinephrine on regional brain blood flow during CPR in a swine model. Ann Emerg Med . 1986;;15:1138-1144.
43 +
Gonzalez ER, Ornato JP, Garnett AR, Levine RL, Young DS, Racht EM.  Dose-dependent vasopressor response to epinephrine during CPR in human beings. Ann Emerg Med . 1989;;18:920-926.
44 +
Paradis NA, Martin GB, Rosenberg J, et al.  The effect of standard- and high-dose epinephrine on coronary perfusion pressure during prolonged cardiopulmonary resuscitation. JAMA . 1991;;265:1139-1144.
45 +
Brown CG, Martin DR, Pepe PE, et al.  A comparison of standard-dose and high-dose epinephrine in cardiac arrest outside the hospital. N Engl J Med . 1992;;327:1051-1055.
46 +
Stiell IG, Hebert PC, Weitzman BN, et al.  High-dose epinephrine in adult cardiac arrest. N Engl J Med . 1992;;327:1045-1050.
47 +
Callaham M, Madsen CD, Barton CW, Saunders CE, Pointer J.  A randomized clinical trial of high-dose epinephrine and norepinephrine vs standard-dose epinephrine in prehospital cardiac arrest. JAMA . 1992;;268:2667-2672.
48 +
Kern KB, Lancaster L, Goldman S, Ewy GA.  The effect of coronary artery lesions on the relationship between coronary perfusion pressure and myocardial blood flow during cardiopulmonary resuscitation in pigs. Am Heart J . 1990;;120:324-332.
49 +
Paradis NA, Martin GB, Rivers EP, et al.  Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation. JAMA . 1990;;263:1106-1113.
50 +
Halperin HR, Chandra NC, Blair DM, Tsitlik JE.  The total force applied to the sternum determines vascular pressures during active compression-decompression and standard cardiopulmonary resuscitation. Circulation . 1994;;90:I-5.
51 +
Shultz JJ, Mianulli MJ, Gisch TM, Coffeen PR, Haidet GC, Lurie KG.  Comparison of exertion required to perform standard and active compression-decompression cardiopulmonary resuscitation. Resuscitation . 1995;;29:23-31.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Kouwenhoven WB, Jude JR, Knickerbocker GG.  Closed-chest cardiac massage. JAMA . 1960;;173: 1064-1067.
2 +
Emergency Cardiac Care Committee and Subcommittees, American Heart Association.  Guidelines for cardiopulmonary resuscitation and emergency cardiac care. JAMA . 1992;;268(theme issue): 2171-2298.
3 +
Niemann JT.  Cardiopulmonary resuscitation. N Engl J Med . 1992;;327:1075-1080.
4 +
Stiell IG, Wells GA, Hébert PC, Laupacis A, Weitzman BN.  Association of drug therapy with survival in cardiac arrest: limited role of advanced cardiac life support drugs. Acad Emerg Med . 1995;; 2:264-273.
5 +
Halperin HR, Weisfeldt ML.  New approaches to CPR: four hands, a plunger, or a vest. JAMA . 1992;; 267:2940-2941.
6 +
Sack JB, Kesselbrenner MB, Bregman D.  Survival from in-hospital cardiac arrest with interposed abdominal counterpulsation during cardiopulmonary resuscitation. JAMA . 1992;;267:379-385.
7 +
Halperin HR, Tsitlik JE, Gelfand M, et al.  A preliminary study of cardiopulmonary resuscitation by circumferential compression of the chest with use of a pneumatic vest. N Engl J Med . 1993;; 329:762-768.
8 +
Lurie KG, Lindo C, Chin J.  CPR: the P stands for plumber's helper. JAMA . 1990;;264:1661.
9 +
Lurie KG.  Active compression-decompression CPR: a progress report. Resuscitation . 1994;;28: 115-122.
10 +
Cohen TJ, Tucker KJ, Redberg RF, et al.  Active compression-decompression resuscitation: a novel method of cardiopulmonary resuscitation. Am Heart J . 1992;;124:1145-1150.
11 +
Lindner KH, Pfenninger EG, Lurie KG, Schuermann W, Lindner IM, Ahnefeld FW.  Effects of active compression-decompression resuscitation on myocardial and cerebral blood flow in pigs. Circulation . 1993;;88:1254-1263.
12 +
Tucker KJ, Khan JH, Savitt MA.  Active compression-decompression resuscitation: effects on pulmonary ventilation. Resuscitation . 1993;;26:125-131.
13 +
Chang MW, Coffeen P, Lurie KG, et al.  Augmentation of late diastolic coronary flow velocity: the mechanism of improved myocardial perfusion during active compression-decompression cardiopulmonary resuscitation? Circulation . 1993;;88:I-193.
14 +
Chang MW, Coffeen P, Lurie KG, Shultz JJ, Bache RJ, White CW.  Active compression-decompression CPR improves vital organ perfusion in a dog model of ventricular fibrillation. Chest . 1994;; 106:1250-1259.
15 +
Idris AH, Wenzel V, Tucker KJ, Orban DJ.  Chest compression ventilation: a comparison of standard CPR and active-compression/decompression CPR. Acad Emerg Med . 1994;;1:A17-A18.
16 +
Carli PA, De La Coussaye JE, Riou B, Sassine A, Eledjam JJ.  Ventilatory effects of active compression-decompression in dogs. Ann Emerg Med . 1994;;24:890-894.
17 +
Tucker KJ, Khan J, Idris A, Savitt MA.  The biphasic mechanism of blood flow during cardiopulmonary resuscitation: a physiologic comparison of active compression-decompression and high-impulse manual external cardiac massage. Ann Emerg Med . 1994;;24:895-906.
18 +
Wik L, Naess PA, Ilebekk A, Steen PA.  Simultaneous active compression-decompression and abdominal binding increase carotid blood flow additively during cardiopulmonary resuscitation (CPR) in pigs. Resuscitation . 1994;;28:55-64.
19 +
Cohen TJ, Tucker KJ, Lurie KG, et al.  Active compression-decompression: a new method of cardiopulmonary resuscitation. JAMA . 1992;;267:2916-2923.
20 +
Tucker KJ, Redberg RF, Schiller NB, Cohen TJ.  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.
21 +
Guly UM, Robertson CE.  Does active decompression improve the haemodynamic state during CPR? Resuscitation . 1994;;28:S27.
22 +
Malzer R, Knappitsch G, Zeiner A, Sterz F, Laggner AN.  Active compression-decompression resuscitation: effects on hemodynamics and pulmonary ventilation in 20 patients. Resuscitation . 1994;; 28:S5.
23 +
Rivers EP, McGeorge FT, Martin GB, et al.  Hemodynamic comparison of mechanical, standard, and active compression-decompression CPR in human cardiac arrest. Acad Emerg Med . 1994;;1:A19-A20.
24 +
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.
25 +
Orliaguet GA, Carli PA, Rozenberg A, Janniere D, Sauval P, Delpech P.  End-tidal carbon dioxide during out-of-hospital cardiac arrest resuscitation: comparison of active compression-decompression and standard CPR. Ann Emerg Med . 1995;; 25:48-51.
26 +
Lurie KG, Shultz JJ, Callaham ML, et al.  Evaluation of active compression-decompression CPR in victims of out-of-hospital cardiac arrest. JAMA . 1994;;271:1405-1411.
27 +
Schwab TM, Callaham ML, Madsen CD, Utecht TA.  A randomized clinical trial of active compression-decompression CPR vs standard CPR in out-of-hospital cardiac arrest in two cities. JAMA . 1995;; 273:1261-1268.
28 +
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.
29 +
Tucker KJ, Galli F, Savitt MA, Kahsai D, Bresnahan L, Redberg RF.  Active compression-decompression resuscitation: effect on resuscitation success after in-hospital cardiac arrest. J Am Coll Cardiol . 1994;;24:201-209.
30 +
Teng EL, Chui HC.  The Modified Mini-Mental State (3MS) Examination. J Clin Psychiatry . 1987;; 48:314-318.
31 +
The Brain Resuscitation Clinical Trial II Study Group.  A randomized clinical trial of calcium entry blocker administration to comatose survivors of cardiac arrest: design, methods, and patient characteristics. Control Clin Trials . 1991;;12:525-545.
32 +
O'Brien PC, Fleming TR.  A multiple testing procedure for clinical trials. Biometrics . 1979;;35: 549-556.
33 +
Zar JH. Biostatistical Analysis . Englewood Cliffs, NJ: Prentice-Hall Inc; 1984;.
34 +
Fleiss JL. The Design and Analysis of Clinical Experiments . New York, NY: John Wiley & Sons Inc; 1986;.
35 +
Hosmer DW, Lemeshow S. Applied Logistic Regression . New York, NY: John Wiley & Sons Inc; 1989;.
36 +
Rudikoff MT, Maughan WL, Effron M, Freund P, Weisfeldt ML.  Mechanisms of blood flow during cardiopulmonary resuscitation. Circulation . 1980;; 61:345-352.
37 +
Chandra N, Weisfeldt ML, Tsitlik J, et al.  Augmentation of carotid flow during cardiopulmonary resuscitation by ventilation at high airway pressure simultaneous with chest compression. Am J Cardiol . 1981;;48:1053-1063.
38 +
Tucker KJ, Idris A.  Clinical and laboratory investigations of active compression-decompression cardiopulmonary resuscitation. Resuscitation . 1994;; 28:1-7.
39 +
Pell ACH, Pringle SD, Guly UM, Steedman DJ, Robertson CE.  Assessment of the active compression-decompression device (ACD) in cardiopulmonary resuscitation using transoesophageal echocardiography. Resuscitation . 1994;;27:137-140.
40 +
Kosnik JW, Jackson RE, Keats S, Tworek RM, Freeman SB.  Dose-related response of centrally administered epinephrine on the change in aortic diastolic pressure during closed-chest massage in dogs. Ann Emerg Med . 1985;;14:204-208.
41 +
Brown CG, Werman HA, Davis EA, Hobson J, Hamlin RL.  The effects of graded doses of epinephrine on regional myocardial blood flow during cardiopulmonary resuscitation in swine. Circulation . 1987;;75:491-497.
42 +
Brown CG, Werman HA, Davis EA, Hamlin R, Hobson J, Ashton JA.  Comparative effects of graded doses of epinephrine on regional brain blood flow during CPR in a swine model. Ann Emerg Med . 1986;;15:1138-1144.
43 +
Gonzalez ER, Ornato JP, Garnett AR, Levine RL, Young DS, Racht EM.  Dose-dependent vasopressor response to epinephrine during CPR in human beings. Ann Emerg Med . 1989;;18:920-926.
44 +
Paradis NA, Martin GB, Rosenberg J, et al.  The effect of standard- and high-dose epinephrine on coronary perfusion pressure during prolonged cardiopulmonary resuscitation. JAMA . 1991;;265:1139-1144.
45 +
Brown CG, Martin DR, Pepe PE, et al.  A comparison of standard-dose and high-dose epinephrine in cardiac arrest outside the hospital. N Engl J Med . 1992;;327:1051-1055.
46 +
Stiell IG, Hebert PC, Weitzman BN, et al.  High-dose epinephrine in adult cardiac arrest. N Engl J Med . 1992;;327:1045-1050.
47 +
Callaham M, Madsen CD, Barton CW, Saunders CE, Pointer J.  A randomized clinical trial of high-dose epinephrine and norepinephrine vs standard-dose epinephrine in prehospital cardiac arrest. JAMA . 1992;;268:2667-2672.
48 +
Kern KB, Lancaster L, Goldman S, Ewy GA.  The effect of coronary artery lesions on the relationship between coronary perfusion pressure and myocardial blood flow during cardiopulmonary resuscitation in pigs. Am Heart J . 1990;;120:324-332.
49 +
Paradis NA, Martin GB, Rivers EP, et al.  Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation. JAMA . 1990;;263:1106-1113.
50 +
Halperin HR, Chandra NC, Blair DM, Tsitlik JE.  The total force applied to the sternum determines vascular pressures during active compression-decompression and standard cardiopulmonary resuscitation. Circulation . 1994;;90:I-5.
51 +
Shultz JJ, Mianulli MJ, Gisch TM, Coffeen PR, Haidet GC, Lurie KG.  Comparison of exertion required to perform standard and active compression-decompression cardiopulmonary resuscitation. Resuscitation . 1995;;29:23-31.

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