Clinical and laboratory investigations of active compression-decompression cardiopulmonary resuscitation

Based upon an anecdotal report of successful resuscitation using a toilet plunger, Cohen and co-workers have developed and investigated a hand-held suction cup as an adjunct to standard manual CPR. This new method, called active compression-decompression cardiopulmonary resuscitation, utilizes a device which is placed over the mid-sternum, approximately 1-2 inches above the lower rib cage border. Active compression-decompression cardiopulmonary resuscitation is then performed in accordance with American Heart Association guidelines at a rate equal to 80-100/min using a 50% duty cycle and compression depth of 1.5-2.0 inches. Initial studies using the ACD device in both models and human subjects late after cardiac arrest have demonstrated improved cardiopulmonary hemodynamics when compared to standard manual CPR. Transophageal echocardiographic studies in human subjects have shown increased left ventricular filling during active decompression suggesting that active chest decompression improves venous return to the heart thus increasing left ventricular volume and stroke volume. Improved resuscitation success has also been documented in human subjects after in-hospital and pre-hospital cardiac arrest. Active compression-decompression cardiopulmonary resuscitation is a simple method which utilizes a hand held suction cup as an interface between rescuer and victim during closed chest circulatory support. This method allows for standard manual cardiopulmonary resuscitation with the addition of active chest wall decompression and appears to be a beneficial adjunct to standard manual cardiopulmonary resuscitation.