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ACD versus standard CPR in a prehospital setting
W Panzer1, M Bretthauer, H Klingler
1Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Germany.
Insights
Active compression-decompression cardiopulmonary resuscitation (ACD-CPR) did not improve survival outcomes compared to standard CPR in out-of-hospital cardiac arrest patients. No significant differences were observed in hospital discharge or neurological status between the two methods.
Area of Science:
- Emergency Medicine
- Cardiology
- Resuscitation Science
Background:
- Studies suggest active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) may improve hemodynamic parameters in cardiac arrest.
- However, clinical results for ACD-CPR in out-of-hospital cardiac arrest (OHCA) patients are inconsistent.
Purpose of the Study:
- To evaluate the effectiveness of ACD-CPR compared to standard CPR (STD-CPR) in adult patients with prehospital cardiac arrest.
Main Methods:
- A retrospective, non-randomized study of 152 adult OHCA patients (excluding trauma/hypothermia).
- Patients received either STD-CPR or ACD-CPR, with ACD devices rotated monthly among rescue units.
- Outcomes assessed included return of spontaneous circulation (ROSC), hospital admission, 24-hour survival, hospital discharge, and neurological outcome.
Main Results:
- 70 patients received STD-CPR and 82 received ACD-CPR; groups were comparable at baseline.
- No significant differences in hospital discharge or neurological outcome were found between STD-CPR and ACD-CPR.
- Interestingly, patients achieving ROSC showed better hospital admission, 24-hour survival, and discharge rates with STD-CPR.
Conclusions:
- ACD-CPR did not demonstrate a significant benefit over STD-CPR in terms of hospital discharge or neurological outcome for OHCA patients.
- The study did not find significant differences in other measured endpoints or subgroups.
Background:
Animal and human studies in cardiac arrest demonstrate significant improvements in systolic blood pressure, coronary perfusion pressure and total brain and myocardial blood flow with active compression-decompression (ACD) cardiopulmonary resuscitation (CPR). The results of recent studies in patients with out-of-hospital cardiac arrest and use of ACD-CPR are non-uniform and require supplementation.
Methods:
In a retrospective non-randomised design, 152 adult patients with prehospital cardiac arrest, not caused by trauma or hypothermia, were studied. Compressions were performed according to the recommendations of the American Heart Association. Three ACD devices were assigned to seven rescue units changing monthly. Study end-points were the rates of return of spontaneous circulation (ROSC), admission to hospital, survival at 24h, hospital discharge and neurologic outcome.
Results:
70 (46%) patients underwent standard (STD) CPR and 82 (54%) patients were treated with ACD-CPR. Both groups were comparable with regard to age, sex, witnessed cardiac arrests, bystander CPR, cause of arrest, time intervals, number of defibrillations, and total amount of epinephrine. No significant differences in outcome could be found: 20 patients (29%) who received STD-CPR, and 14 patients (17%) who underwent ACD-CPR survived to hospital discharge. Neither at other end-points nor in any subgroups could any significant differences be discovered. Patients regaining ROSC showed a significant difference in favour of STD-CPR for the end-points of hospital admission, 24-h survival and hospital discharge.
Conclusion:
No significant differences in hospital discharge and neurological outcome were found between STD-CPR and ACD-CPR.