ACTIVE COMPRESSION-DECOMPRESSION CARDIOPULMONARY-RESUSCITATION DOES NOT IMPROVE SURVIVAL IN PATIENTS WITH PREHOSPITAL CARDIAC-ARREST IN A PHYSICIAN-MANNED EMERGENCY MEDICAL SYSTEM

Object: To examine the efficacy of a new method of cardiac resuscitati on, active compression-decompression cardiopulmonary resuscitation (AC D CPR), in prehospital cardiac arrest. Design: Prospective, randomized , controlled trial. Setting: Physician manned Mobile Intensive Care Un it (MICU) of a university hospital, serving a population of 200,000. P articipants: Adult patients with prehospital nontraumatic cardiac arre st treated by the MICU. Interventions: Patients were randomized to sta ndard 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 devic e. In both groups, advanced life support was performed as recommended by the AHA. Measurements and Main Results: Rate of patients regaining a spontaneous circulation (ROSC), hospital discharge rate, and mean ca rbon 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 (gr oup 1 v group 2: n.s.). Anatomic conditions precluded the application of ACD CPR in 5 patients. The new technique was found to impose greate r physical efforts than STD CPR. Capnography was performed in 23 patie nts (mean value: STD CPR: 11.9 +/- 4.7 mmHg, ACD CPR: 13.7 +/- 4.9 mmH g [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 card iac arrest. (C) 1996 by W.B. Saunders Company