Cardiac Arrest: Active compression-decompression CPR increased 24 hour survival.

Clinical bottom line (level 2b)

  1. Patients who had a cardiac arrest in-hospital who were given active compression-decompression CPR were more likely to be resuscitated than those given standard CPR (NNT = 3 at 60 minutes) .
  2. Patients given active compression-decompression CPR are more likely to survive for more than 24 hours (NNT = 3 at 24 hours) .
  3. There is no clear effect on the number of patients discharged alive from hospital.
Cohen et al: N Engl J Med 1993; 329: 1918-1921
Expires October 2003

The study

Single-blinded ?concealed quasi-randomised trial with intention-to-treat
Setting: Medical intensive care unit, coronary care unit, cardiac catheterisation laboratory and medical wards, USA

62 patients (aged mean 68 years old, 73% male) non-traumatic, witnessed cardiac arrest

Excluded if
  • <18 years old
  • respiratory arrest without haemodynamic collapse
  • inability to achieve endotracheal intubation within 15 minutes of arrest
  • do-not-resuscitate order


    • Control Group: (n = 33, 33 analysed): standard cardiopulmonary resuscitation; 80-100 compressions per minute, depth of compression 3.8-5.1 cm and 50% of cycle spent in compression
    Experimental Group: (n = 29, 29 analysed): active compression-decompression cardiopulmonary resuscitation administered with Ambu CardioPump; 29.5-50.0 kg pressure, equivalent to 3.8-5.1 cm depth

    100% followed for ?
    Outcome notes:
    • resuscitation : return of pulse and systolic blood pressure (>90 mmHg) for at least 1 hour

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    resuscitation 60 minutes 10
    (30.3%)    		 18
    (62.1%)    		 105%
    (13.0% to 270%)    		 31.8%
    (8.15% to 55.4%)    		 3
    (2 to 12)
    survival = 24 hours 24 hours 3
    (9.09%)    		 13
    (44.8%)    		 393%
    (56% to 1460%)    		 35.7%
    (15.2% to 56.3%)    		 3
    (2 to 7)
    discharge from hospital unknown 0
    (0.00%)    		 2
    (6.90%)    		 %
    (% to %)    		 6.90%
    (-2.33% to 16.1%)    		 15
    (NNT = 6 to infinity;
    NNH = 43 to infinity)

    Comments

    1. The study was too small to show a clear effect on discharge from hospital.
    2. Neurological impairment (as determined by the Glasgow coma score)was higher in the active compression-decompression group (mean 8.0 +/- 1.3) than the standard CPR group (mean 3.5 +/- 0.3).
    3. At least 60% of patients had preexisting terminal illness.
    4. CPR was carried out according to American Heart Association guidelines by 3 internal medicine residents.

    Citation

    1. Cohen TJ, Goldner BG, Maccaro PC, et al: A comparison of active compression-decompression cardiopulmonary resuscitation with standard cardiopulmonary resuscitation for cardiac arrests occurring in the hospital.. N Engl J Med 1993; 329: 1918-1921
    Contributor: Clare Wotton & Chris Ball, October 1999
    Reviewer: Malcolm Daniel

    Clinical Question.
    Patient cardiac arrest
    Intervention or Exposure active compression-decompression CPR
    Comparison standard CPR
    Outcome survival