title: Active compression-decompression cardiopulmonary resuscitation does not improve survival in patients with prehospital cardiac arrest in a physician-manned emergency medical system.
abstract: OBJECTIVE
  To examine the efficacy of a new method of cardiac resuscitation, active compression-decompression cardiopulmonary resuscitation (ACD CPR), in prehospital cardiac arrest.
  
  
  METHODS
  Prospective, randomized, controlled trial.
  
  
  METHODS
  Physician-manned Mobile Intensive Care Unit (MICU) of a university hospital, serving a population of 200,000.
  
  
  METHODS
  Adult patients with prehospital nontraumatic cardiac arrest treated by the MICU.
  
  
  METHODS
  Patients were randomized to standard chest compression according to American Heart Association (AHA) recommendations (group 1, 30 patients) or to the new technique (group 2, 26 patients). ACD was performed by use of a hand-held suction device. In both groups, advanced life support was performed as recommended by the AHA.
  
  
  RESULTS
  Rate of patients regaining a spontaneous circulation (ROSC), hospital discharge rate, and mean carbon dioxide content during resuscitation were recorded. ROSC rates in groups 1 and 2 were 40% and 38.5%, respectively. Four patients (13.3%) in group 1 and three patients (11.5%) in group 2 were discharged (group 1 v group 2: n.s.). Anatomic conditions precluded the application of ACD CPR in 5 patients. The new technique was found to impose greater physical efforts than STD CPR. Capnography was performed in 23 patients (mean value: STD CPR: 11.9 +/- 4.7 mmHg, ACD CPR: 13.7 +/- 4.9 mmHg [n.s.]).
  
  
  CONCLUSIONS
  ACD CPR did not improve, outcome and practical performance was complicated. Therefore, this technique should not be performed routinely, or without strict supervision in prehospital cardiac arrest.
authors.affiliation: Department of Anesthesiology and Surgical Intensive Care, Mannheim University Hospital, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Luiz
authors.forename: K
authors.initials: K
authors.lastname: Ellinger
authors.forename: C
authors.initials: C
authors.lastname: Denz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged