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Standard Cardiopulmonary Resuscitation Versus Active Compression-Decompression Cardiopulmonary Resuscitation With Augmentation of Negative Intrathoracic Pressure for Out-of-Hospital Cardiac Arrest: A Randomised Trial
Study Questions:
What is the effectiveness and safety of the compression-decompression cardiopulmonary resuscitation (CPR) device on survival with favorable neurological function after out-of-hospital cardiac arrest?
Methods:
A randomized trial was conducted in 46 emergency medical service agencies (serving 2.3 million people) in urban, suburban, and rural areas of the United States. Outcomes for patients with out-of-hospital cardiac arrest were assessed according to Utstein guidelines. Patients were randomized to standard CPR or active compression-decompression CPR with augmented negative intrathoracic pressure (via an impedance-threshold device). Adults (presumed age or age ≥18 years) who had a nontraumatic arrest of presumed cardiac cause were eligible. The primary endpoint was survival to hospital discharge with favorable neurological function (modified Rankin scale score of ≤3).
Results:
There was no difference between groups for the following: time from emergency call to first response time, 6.5 minutes; duration of CPR, 27 minutes; mean age, 67 years; 66% male; 47% witnessed, 43% bystander CPR; initial cardiac arrest rhythm asystole 47%, ventricular fibrillation or pulseless ventricular tachycardia 32%, and pulseless electrical activity 21%. Forty-seven (6%) of 813 controls survived to hospital discharge with favorable neurological function compared with 75 (9%) of 840 patients in the intervention group (odds ratio, 1.58; 95% confidence interval, 1.07-2.36; p = 0.019). Seventy-four (9%) of 840 patients survived to 1 year in the intervention group compared with 48 (6%) of 813 controls (p = 0.03), with equivalent cognitive skills, disability ratings, and emotional-psychological statuses in both groups. The overall major adverse event rate did not differ between groups, but more patients had pulmonary edema in the intervention group (94 [11%] of 840) than did controls (62 [7%] of 813; p = 0.015).
Conclusions:
Active compression-decompression CPR with augmentation of negative intrathoracic pressure should be considered as an alternative to standard CPR to increase long-term survival after cardiac arrest.
Perspective:
Out-of-hospital cardiac arrest has about a 5% survival rate in part related to poor techniques, but also because standard CPR methods are inefficient and insufficient for heart and brain perfusion. Augmentation of negative intrathoracic pressure during the decompression phase can increase cardiac and cerebral perfusion. This large controlled study validates the experimental data and clinical experience demonstrating the advantage of using the CPR device (ResQPump, also called CardioPump) and the impedance-threshold device (ResQPOD), both of which are manufactured by Advanced Circulatory Systems (Roseville, MN, USA).
Keywords: Pulmonary Edema, Cognition, Emergency Medical Services, Electric Impedance, Cardiopulmonary Resuscitation, Ventricular Fibrillation, Heart Arrest, Survivors, Out-of-Hospital Cardiac Arrest, Tachycardia, Ventricular, Survival Rate, United States
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