Active chest compression-decompression for cardiopulmonary resuscitation

Authors


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 on use of active compression decompression cardiopulmonary resuscitation have results which are discordant.

Objectives

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

Search strategy

We searched the Cochrane Controlled Trials Register (May 2002), MEDLINE and EMBASE. We checked the reference list of retrieved articles and contacted enterprises manufacturing the active decompression devices.

Selection criteria

All randomised or quasi-randomised studies comparing active compression-decompression cardiopulmonary resuscitation compared with standard manual cardiopulmonary resuscitation 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. All data were analysed on an intention-to-treat basis. The authors of the primary studies were contacted for more information 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

Twelve trials were included: 10 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 4 trials. The two in-hospital studies were very different in quality (A and C) and size (773 and 53 patients). Both found no differences between ACDR CPR and STR in any outcome. Trials conducted in out-of-hospital settings cumulated 4162 patients. There were no differences between ACDR CPR and STR for mortality either immediately (RR 0.98 [95% CI 0.94 - 1.03]) or at hospital discharge (RR 0.99 [95% CI 0.98 - 1.01]). The pooled RR of neurological impairment, any severity, was 1.71 [95% CI 0.90 - 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 - 9.83]). However, assessment of neurological outcome was limited and there were few patients with neurological damage. There was no difference between ACDR CPR and STR with regard complications such as rib or sternal fractures, pneumothorax or hemothorax (RR 1.09 [95% CI 0.86 - 1.38]). Skin trauma and ecchymosis were more frequent with ACDR CPR.

Reviewer's conclusions

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

Plain language summary

Synopsis

Active compression-decompression using a hand held device for emergency heart massage has some disadvantages and no advantages over the usual practice of cardiopulmonary resuscitation.

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