REVIEW OF ACTIVE COMPRESSION-DECOMPRESSION CARDIOPULMONARY-RESUSCITATION (ACD-CPR) - ANALYSIS OF IATROGENIC COMPLICATIONS AND THEIR BIOMECHANICAL EXPLANATION

Our review takes a critical look at the active compression-decompressi on technique (ACD) for cardiopulmonary resuscitation (CPR). ACD-CPR wa s developed following a report of successful resuscitation performed b y a medical amateur using a household plunger. The efficacy of the pri nciple of active decompression has been demonstrated by animal and hum an studies. Potential iatrogenic complications;from the CardioPump wer e evaluated only when large clinical trials were already underway. Our prospective analysis of autopsy patients and systematic randomised st udies in corpses prove that ACD-CPR using the CardioPump considerably increases the rate of iatrogenic complications and especially of stern um fractures. The experimental use of the CardioPump in corpses and th e analysis of a variety of different parameters, especially of the rub ber cushion pads mounted in the silicone cup to prevent skin abrasions , revealed a statistically significant correlation between sternum fra ctures and female sex (P<0.01) and usage of the rubber cushion pad (P= 0.045). Biomechanical studies showed that the transmission of forces f rom the CardioPump is greatly dependent on chest shape. The lower the sternum is sunken compared with the surrounding structures, the higher the force which is transmitted via the central area of the device ont o the sternum. The rubber cushion pad shortens the distance between Ca rdioPump and sternum by 5 mm and therefore increases the sternal loadi ng. Sex differences in the shape of the sternum and especially the thi ckness may account for the significant correlation between sternum fra ctures and female sex. (C) 1997 Elsevier Science Ireland Ltd.