Active chest compression-decompression for cardiopulmonary resuscitation

 

Abstract

Background

Active compression-decompression cardiopulmonary resuscitation (ACDR CPR) uses a hand-held suction device, applied mid-sternum, to compress the chest then actively decompress the chest after each compression. Randomised controlled trials testing this device have shown discordant results.

Objectives

To determine clinical effects and safety of active compression-decompression cardiopulmonary resuscitation compared with standard manual cardiopulmonary resuscitation (STR).

Search methods

We searched the Cochrane Central Register of Controlled Trials, Issue 2 2010, MEDLINE (1966 to June 2010) and EMBASE (1980 to June 2010). We checked the reference list of retrieved articles, contacted experts in the field and searched ClinicalTrials.gov.

Selection criteria

All randomised or quasi-randomised studies comparing active compression-decompression with standard manual chest compression, in adults with a cardiac arrest who received cardiopulmonary resuscitation by a trained medical or paramedical team.

Data collection and analysis

Data were independently extracted, on an intention-to-treat basis. The authors of the primary studies were contacted when needed. Studies were cumulated, if appropriate, and pooled relative risk (RR) estimated. Subgroup analysis according to setting (out of hospital or in hospital) and attending team composition (with physician or paramedic only) were predefined.

Main results

In this update, eight new related publications were found but they did not fulfil inclusion criteria or concerned patients already reported in other publications. Ten trials are included: eight were in out-of-hospital settings, one set in-hospital only and one had both in-hospital and out-of-hospital components. Allocation concealment was adequate in four studies. The two in-hospital studies were different in quality and size (773 and 53 patients). Both found no differences between ACDR CPR and STR in any outcome.

Out-of-hospital trials cumulated 4162 patients. There were no differences between ACDR CPR and STR for mortality either immediately (RR 0.98, 95% CI 0.94 to 1.03) or at hospital discharge (RR 0.99, 95%CI 0.98 to 1.01). The pooled RR of neurological impairment, any severity, was 1.71 (95%CI 0.90 to 3.25), with a non-significant trend to more frequent severe neurological damage in survivors of ACDR CPR (RR 3.11, 95% CI 0.98 to 9.83). However, assessment of neurological outcome was limited and few patients had neurological damage.

There was no difference between ACDR CPR and STR with regard complications such as rib or sternal fractures, pneumothorax or haemothorax (RR 1.09, 95% CI 0.86 to 1.38). Skin trauma and ecchymosis were more frequent with ACDR CPR.

Authors' conclusions

Active chest compression-decompression in patients with cardiac arrest is not associated with clear benefit.

 

Plain language summary

Active compression-decompression using a hand-held device for emergency heart massage

During standard cardiopulmonary resuscitation (heart massage) for cardiac arrest (arrest of the heart) the chest is compressed manually and repeatedly by hand. This is a temporary method that pumps blood and oxygen to the brain via the heart. During standard cardiopulmonary resuscitation the chest is not manually decompressed. Active chest compression-decompression is an alternative method of heart massage and uses a hand held suction device to compress the chest then decompress the chest after each compression. Comparison of these techniques showed active chest compression-decompression to have no advantage for patients and had some drawbacks compared to standard cardiopulmonary resuscitation

 

摘要

背景

“主動按壓減壓胸部按壓”心肺復甦術在心肺復甦術之使用

“主動按壓減壓胸部按壓心肺復甦術”(A ctive compressiondecompression cardiopulmonary resuscitation (是一種手提式的抽吸裝置(向下擠壓胸骨後再抽氣以放開受壓胸骨),用來在心肺復甦術中按壓胸骨中段進行心臟按摩。各隨機試驗對於其在心肺復甦術之使用的效果及影響並不全然一致。

目標

測定“主動按壓減壓胸部按壓”與標準人工心肺復甦術manual cardiopulmonary resuscitation,(STR)之使用中的臨床效用與安全性。

搜尋策略

我們搜尋了Cochrane Central Register of Controlled Trials, Medline跟EMBASE的資料庫，最後一次的搜尋是2004年1月。我們查核了相關的文獻及聯絡了製造器械自動胸部按壓的公司企業。

選擇標準

所有隨機或半隨機的臨床試驗，這些試驗比較了心臟停止的成人接受由受過訓練之之醫療或輔助醫療團隊執行主動按壓減壓胸部按壓與標準人工心肺復甦術後的結果。

資料收集與分析

這些資料被獨立地取出分析。所有的資料是以意圖治療(intention to treat)的標準來分析。若有需要，原試驗的創始人會被聯絡以詢問相關事宜。若情況合宜，這些試驗結果將被累積，並估計總體的相對風險(pooled relative risk)。而次群體的分析，如環境(醫院內或醫院外)以及主治團隊的組成(由醫師或僅有輔助醫療人員)必須事先界定。

主要結論

我們引用了10個試驗。其中8個是醫院外情境，1個是醫院內情境，最後1個是院內及院外皆有。其中有4個試驗條件配置的盲法(allocation concealment)相當恰當。醫院內情境的這2個試驗在品質(A級及C級)及病人數上(773名病患及53名病患)差異相當大。但這兩個試驗皆發現”主動按壓減壓胸部按壓”標準人工心肺復甦術在許多結果上並沒有差異。醫院外情境的試驗則累積了4162個病人數。關於病人立即之死亡率(相對危險性0.98，95%之信心區間為0.94至1.03)或出院後之死亡率(相對機率0.99，95%之信心區間為0.98至1.01)，“主動按壓減壓胸部按壓”與一般手動胸部按壓急救也沒有明顯差異。關於不論任何程度之神經系統損傷的總合相對風險是1.71(95%信心區間0.98 – 1.01)。但“主動按壓減壓胸部按壓”急救在輕微至嚴重之神經系統傷害的相對風險則是3.11(95%信心區間0.98 – 9.83)。然而，評估神經系統傷害並不容易且受到神經系統傷害的病人數並不多。至於相關的併發症如肋骨或胸骨骨折，氣胸或血胸兩者並無差異(相對風險1.09，95%信心區間0.86至1.38)。皮膚傷害或淤血則是主動按壓減壓胸部按壓頻率較高。

作者結論

“主動按壓減壓胸部按壓”急救對於心臟停止的病人並沒有帶來明顯的助益。

翻譯人

本摘要由臺北榮民總醫院楊凱仲翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

“主動按壓減壓胸部按壓“急救對於緊急狀況下心臟按摩有某些缺點並且相較於一般手動胸部按壓急救並沒有明顯的好處。在一般手動胸部按壓急救時，病人的胸口是以徒手來反覆上下地壓胸。這是一個使心臟能打出血液並傳送氧氣到大腦的暫時性方法。於一般手動胸部按壓急救時，病人胸口在被按壓後並沒有被手動地減壓而是自動彈起，器械自動胸部按壓急救是另一種心臟按摩的方法，是一種手提式的抽吸裝置，其向下擠壓胸骨後再抽氣以放開受壓胸骨。研究顯示“主動按壓減壓胸部按壓”急救相較於一般手動胸部按壓急救並沒有明顯的好處而且多出一些缺點。