Benefit of active compression-decompression cardiopulmonary resuscitation as a prehospital advanced cardiac life support. A randomized multicenter study.
BACKGROUND
We compared short-term prognosis of active compression-decompression (ACD) and standard (STD) cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrests.


RESULTS
We randomized advanced cardiac life support (ACLS) with ACD ACLS CPR on odd days and STD ACLS CPR on even days. We measured the rates of return of spontaneous circulation (ROSC), survival at 1 hour (H1), at 24 hours (H24), and at 1 month (D30): hospital discharge (HD); neurological outcome; and complications. Mean times from collapse to basic cardiac life support CPR was 9 minutes and from collapse to ACLS CPR was 21 minutes. Compared with the STD ACLS patients (n = 258), ACD ACLS patients (n = 254) had higher survival rates (ROSC, 44.9% versus 29.8%, P = .0004; H1, 36.6% versus 24.8%, P = .003; H24, 26% versus 13.6%, P = .002; HD without neurological impairment, 5.5% versus 1.9%, P = .03) and a trend for improvement in neurological outcome at D30 (Glasgow-Pittsburgh Outcome Categories = 1.6 +/- 0.8 versus 2.3 +/- 1.1. P = .09). Sternal dislodgements (2.9% versus 0.4%, P = .03) and hemoptysis (5.4% versus 1.3%, P = .01) were more frequent in the ACD ACLS group.


CONCLUSIONS
Despite long time intervals, ACD significantly improved short-term survival rates in out-of-hospital cardiac arrests compared with STD CPR.
Plaisance
P
P
Department of Anesthesiology and Critical Care, Lariboisière University Hospital, Paris, France. dpayen.lariboisiere@invivo.edu
Adnet
F
F
Vicaut
E
E
Hennequin
B
B
Magne
P
P
Prudhomme
C
C
Lambert
Y
Y
Cantineau
J P
JP
Léopold
C
C
Ferracci
C
C
Gizzi
M
M
Payen
D
D
D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000401:mortality; D004562:Electrocardiography; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008021:Life Support Systems; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome