(Circulation. 1997;95:955-961.)
© 1997 American Heart Association, Inc.
Articles |
Benefit of Active Compression-Decompression Cardiopulmonary Resuscitation as a Prehospital Advanced Cardiac Life Support
A Randomized Multicenter Study
SMUR and the Department of Anesthesiology and Critical Care, Lariboisiere University Hospital (P.P., F.A., M.G., D.P.); Biophysic Laboratory, Fernand Widal Hospital (E.V.); SMUR, Saint Denis Hospital (SAMU 93) (B.H.); SMUR and the Department of Anesthesiology and Critical Care, Avicenne University Hospital (SAMU 93) (P.M., C.P.); SMUR and the Department of Anesthesiology and Critical Care, Henri Mondor University Hospital (SAMU 94) (Y.L., J.-P.C.); SMUR and the Department of Anesthesiology and Critical Care, Beaujon University Hospital (SAMU 92) (C.L., C.F.).
Correspondence to Patrick Plaisance, MD, Department of Anesthesiology and Critical Care, Lariboisiere University Hospital, 2 Rue Ambroise Pare, 75475 Paris, France. E-mail dpayen.lariboisiere@invivo.edu.
Background We compared short-term prognosis of active compression-decompression (ACD) and standard (STD) cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrests.
Methods and Results We randomized advanced cardiac life support (ACLS) with ACD ACLS CPR on odd days and STD ACLS CPR on even days. We measured the rates of return of spontaneous circulation (ROSC), survival at 1 hour (H1), at 24 hours (H24), and at 1 month (D30); hospital discharge (HD); neurological outcome; and complications. Mean times from collapse to basic cardiac life support CPR was 9 minutes and from collapse to ACLS CPR was 21 minutes. Compared with the STD ACLS patients (n=258), ACD ACLS patients (n=254) had higher survival rates (ROSC, 44.9% versus 29.8%, P=.0004; H1, 36.6% versus 24.8%, P=.003; H24, 26% versus 13.6%, P=.002; HD without neurological impairment, 5.5% versus 1.9%, P=.03) and a trend for improvement in neurological outcome at D30 (Glasgow-Pittsburgh Outcome Categories=1.6±0.8 versus 2.3±1.1, P=.09). Sternal dislodgments (2.9% versus 0.4%, P=.03) and hemoptysis (5.4% versus 1.3%, P=.01) were more frequent in the ACD ACLS group.
Conclusions Despite long time intervals, ACD significantly improved short-term survival rates in out-of-hospital cardiac arrests compared with STD CPR.
Key Words: cardiopulmonary resuscitation • active compression-decompression • advanced cardiac life support
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