ACD VERSUS STANDARD CPR IN A PREHOSPITAL SETTING

Background: Animal and human studies in cardiac arrest demonstrate sig nificant improvements in systolic blood pressure, coronary perfusion p ressure and total brain and myocardial blood flow with active compress ion-decompression (ACD) cardiopulmonary resuscitation (CPR). The resul ts of recent studies in patients with out-of-hospital cardiac arrest a nd use of ACD-CPR are non-uniform and require supplementation. Methods : In a retrospective non-randomised design, 152 adult patients with pr ehospital cardiac arrest; not caused by trauma or hypothermia, were st udied. Compressions were performed according to the recommendations of the American Heart Association. Three ACD devices were assigned to se ven rescue units changing monthly. Study end-points were the rates of return of spontaneous circulation (ROSC), admission to hospital, survi val at 24 h, hospital discharge and neurologic outcome. Results: 70 (4 6%) patients underwent standard (STD) CPR and 82 (54%) patients were t reated with ACD-CPR. Both groups were comparable with regard to age, s ex, witnessed cardiac arrests, bystander CPR, cause of arrest, time in tervals, number of defibrillations, and total amount of epinephrine. N o significant differences in outcome could be found: 20 patients (29%) who received STD-CPR, and 14 patients (17%) who underwent ACD-CPR sur vived to hospital discharge. Neither at other end-points nor in any su bgroups could any significant differences be discovered. Patients rega ining ROSC showed a significant difference in favour of STD-CPR for th e end-points of hospital admission, 24-h survival and hospital dischar ge. Conclusion: No significant differences in hospital discharge and n eurological outcome were found between STD-CPR and ACD-CPR. Copyright (C) 1996 Elsevier Science Ireland Ltd