A comparison of standard cardiopulmonary resuscitation and active compression-decompression resuscitation for out-of-hospital cardiac arrest

Background We previously observed that shortterm survival after out-of-hosp ital cardiac arrest was greater with active compression-decompression cardi opulmonary resuscitation (CPR) than with standard CPR. In the current study , we assessed the effects of the active compression-decompression method on one-year survival. Methods Patients who had cardiac arrest in the Paris metropolitan area or i n Thionville, France, more than 80 percent of whom had asystole, were assig ned to receive either standard CPR (377 patients) or active compression-dec ompression CPR (373 patients) according to whether their arrest occurred on an even or odd day of the month, respectively. The primary end point was s urvival at one year. The rate of survival to hospital discharge without neu rologic impairment and the neurologic outcome were secondary end points. Results Both the rate of hospital discharge without neurologic impairment ( 6 percent vs. 2 percent, P = 0.01) and the one-year survival rate (5 percen t vs. 2 percent, P = 0.03) were significantly higher among patients who rec eived active compression-decompression CPR than among those who received st and ard CPR. AII patients who survived to one year had cardiac arrests that were witnessed. Nine of 17 one-year survivors in the active compression-de compression group and 2 of 7 in the standard group, respectively, initially had asystole or pulseless electrical activity. In 12 of the 17 survivors w ho had received active compression-decompression CPR, neurologic status ret urned to base line, as compared with 3 of 7 survivors who had received stan dard CPR (P = 0.34). Conclusions Active compression-decompression CPR performed during advanced life support significantly improved long-term survival rates among patients who had cardiac arrest outside the hospital. (N Engl J Med 1999;341:569-75 .) (C)1999, Massachusetts Medical Society.