Efficacy of pneumatic trousers in refractory prehospital cardiopulmonary arrest

Persons refractory to early application of advanced cardiac life support have a dismal prognosis. New modalities are needed to treat this almost universally lethal condition. We have evaluated pneumatic trousers in the treatment of refractory cardiopulmonary arrest. To date 136 patients have been entered into this controlled, prospective, randomized study. All patients were more than 20 years old and in cardiac arrest of apparent cardiac etiology. Patients were excluded if they had arrested secondary to trauma or overdose, or if an IV could not be started. In addition, patients had to be refractory to therapies included in our paramedic standing orders. If at the end of these standing orders the patient remained in arrest, he was entered into the study and pneumatic trousers were applied or not according to a randomized list. The attempted resuscitation was then continued with no other preset variables. The resuscitation and discharge rates for the control group were 21% and 4%, respectively. With pneumatic trousers, resuscitation increased to 33%, and discharge to 9%. The control group in ventricular fibrillation (VF) had a 27% resuscitation rate and a 5% discharge rate. The pneumatic trousers group with VF had a 35% resuscitation rate and a 12% discharge rate. In pulseless idioventricular rhythm (PIVR), the control group had a 0% resuscitation rate and a 0% discharge rate. In marked contrast, for PIVR the pneumatic trousers group had a 35% resuscitation rate and a 9% discharge rate. The control group in asystole (AS) had a 25% resuscitation rate and a 0% discharge rate. The pneumatic trousers group in AS had a 27% resuscitation rate and a 0% discharge rate. The improvement in resuscitation rate with pneumatic trousers was statistically significant only for the initial rhythm of PIVR (P less than .05). The pneumatic trousers improved resuscitation and discharge rates for refractory VF, but not to a statistically significant degree. These somewhat enhanced resuscitation and discharge rates with the pneumatic trousers make it an adjunct to be considered in refractory arrest.