ACD versus standard CPR in a prehospital setting.
BACKGROUND
Animal and human studies in cardiac arrest demonstrate significant improvements in systolic blood pressure, coronary perfusion pressure and total brain and myocardial blood flow with active compression-decompression (ACD) cardiopulmonary resuscitation (CPR). The results of recent studies in patients with out-of-hospital cardiac arrest and use of ACD-CPR are non-uniform and require supplementation.


METHODS
In a retrospective non-randomised design, 152 adult patients with prehospital cardiac arrest, not caused by trauma or hypothermia, were studied. Compressions were performed according to the recommendations of the American Heart Association. Three ACD devices were assigned to seven rescue units changing monthly. Study end-points were the rates of return of spontaneous circulation (ROSC), admission to hospital, survival at 24h, hospital discharge and neurologic outcome.


RESULTS
70 (46%) patients underwent standard (STD) CPR and 82 (54%) patients were treated with ACD-CPR. Both groups were comparable with regard to age, sex, witnessed cardiac arrests, bystander CPR, cause of arrest, time intervals, number of defibrillations, and total amount of epinephrine. No significant differences in outcome could be found: 20 patients (29%) who received STD-CPR, and 14 patients (17%) who underwent ACD-CPR survived to hospital discharge. Neither at other end-points nor in any subgroups could any significant differences be discovered. Patients regaining ROSC showed a significant difference in favour of STD-CPR for the end-points of hospital admission, 24-h survival and hospital discharge.


CONCLUSIONS
No significant differences in hospital discharge and neurological outcome were found between STD-CPR and ACD-CPR.
Panzer
W
W
Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Germany.
Bretthauer
M
M
Klingler
H
H
Bahr
J
J
Rathgeber
J
J
Kettler
D
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation / Q000379:methods*; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome