Active chest compression-decompression for cardiopulmonary resuscitation

Background

Active compression-decompression cardiopulmonary resuscitation (ACDR CPR) uses a hand-held suction device, applied mid-sternum, to compress the chest then actively decompress the chest after each compression. Randomised controlled trials testing this device have shown discordant results.

Objectives

To determine clinical effects and safety of active compression-decompression cardiopulmonary resuscitation compared with standard manual cardiopulmonary resuscitation (STR).

Search strategy

We searched the Cochrane Central Register of Controlled Trials, Issue 2 2008, MEDLINE (1966 to May 2008) and EMBASE (1980 to May 2008). We checked the reference list of retrieved articles and contacted experts in the field.

Selection criteria

All randomised or quasi-randomised studies comparing active compression-decompression with standard manual chest compression, in adults with a cardiac arrest who received cardiopulmonary resuscitation by a trained medical or paramedical team.

Data collection and analysis

Data were independently extracted, on an intention-to-treat basis. The authors of the primary studies were contacted when needed. Studies were cumulated, if appropriate, and pooled relative risk (RR) estimated. Subgroup analysis according to setting (out of hospital or in hospital) and attending team composition (with physician or paramedic only) were predefined.

Main results

In this update, four new related publications were found but they did not fulfil inclusion criteria or concerned patients already reported in other publications. Ten trials are included: eight were in out-of-hospital settings, one set in-hospital only and one had both in-hospital and out-of-hospital components. Allocation concealment was adequate in four studies. The two in-hospital studies were different in quality and size (773 and 53 patients). Both found no differences between ACDR CPR and STR in any outcome.

Out-of-hospital trials cumulated 4162 patients. There were no differences between ACDR CPR and STR for mortality either immediately (RR 0.98, 95% CI 0.94 to 1.03) or at hospital discharge (RR 0.99, 95%CI 0.98 to 1.01). The pooled RR of neurological impairment, any severity, was 1.71 (95%CI 0.90 to 3.25), with a non-significant trend to more frequent severe neurological damage in survivors of ACDR CPR (RR 3.11, 95% CI 0.98 to 9.83). However, assessment of neurological outcome was limited and few patients had neurological damage.

There was no difference between ACDR CPR and STR with regard complications such as rib or sternal fractures, pneumothorax or haemothorax (RR 1.09, 95% CI 0.86 to 1.38). Skin trauma and ecchymosis were more frequent with ACDR CPR.

Authors' conclusions

Active chest compression-decompression in patients with cardiac arrest is not associated with clear benefit.