Increased frequency of thorax injuries with ACD-CPR

A prospective, randomised out-of-hospital study in a two-tiered system with active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) versus standard (STD) CPR in patients following non-traumatic cardiac arre st was planned to test the hypothesis that ACD-CPR by the first tier may in crease the occurrence of ventricular fibrillation as compared with STD-CPR. Furthermore, in a later phase of the study, sternal and rib fractures indu ced by both CPR methods were determined by extensive autopsy. After enrolli ng 90 patients the study was terminated because of a high frequency of ches t injuries found at autopsy. Forty-two patients received STD-CPR from the f irst tier and ACD-CPR from the second tier. Thirty-three patients received ACD-CPR only by the first and the second tier, while 15 patients received S TD-CPR only from the first and second tiers. In order to obtain a sufficien tly large control group for autopsy findings after STD-CPR, STD-CPR was per formed in an additional 33 patients within a second period of 4 months. The re was no improvement in the number of patients found in ventricular fibril lation after ACD-CPR as compared to STD-CPR performed by the first tier. In patients undergoing autopsy (n = 35) there were significantly more sternal fractures with ACD-CPR versus STD-CPR (14/15 vs. 6/20; P < 0.005) and rib fractures (13/15 vs. 11/20; P < 0.05) In conclusion, ACD-CPR appears to cau se more CPR-related injuries than does standard CPR, but as a result of a n umber of limitations on this study, this fact cannot be proven beyond doubt . (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.