Phased chest and abdominal compression-decompression versus conventional cardiopulmonary resuscitation in out-of-hospital cardiac arrest

Background-Several methods have been developed to improve the efficacy of m echanical resuscitation, because organ perfusion achieved with conventional manual resuscitation is often insufficient. In animal studies, phased ches t and abdominal compression-decompression resuscitation by use of the Lifes tick device has resulted in a better outcome compared with that of conventi onal resuscitation. In end-of-life patients, an increased coronary perfusio n pressure was achieved. The aim of the present study was to determine the feasibility, safety, and efficacy of the Lifestick compared with convention al resuscitation in patients with sudden nontraumatic out-of-hospital cardi ac arrest. Methods and Results-The crews of 4 mobile intensive care units, staffed by an emergency physician and a paramedic, were trained to use the device. Fif ty patients were randomized by sealed envelopes to either Lifestick (n=24) or conventional (n=26) resuscitation. No differences were found regarding d emographic and logistical conditions between the groups. Nineteen of the pa tients (73%) with conventional resuscitation had ventricular fibrillation, 13 of whom survived to hospital admission (no survivals with other arrhythm ias) and 7 were discharged. In contrast, in the Lifestick-CPR group, only 9 patients had ventricular fibrillation (38%; P= <0.02; OR, 2.5; 95% CI, 0.6 to 10.6). Four of these 9 patients and 5 of 15 patients with other arrhyth mias survived to hospital admission, but none survived to hospital discharg e. Autopsy in a subgroup of patients who died at the scene revealed less in juries with Lifestick than with conventional resuscitation. Conclusion-Lifestick resuscitation is feasible and safe and may be advantag eous in patients with asystole or pulseless electric activity.