Cardiac Arrest: CPR: active compression-decompression improves survival up to a year.

Clinical bottom line (level 2b)

  1. Patients who have a cardiac arrest in the community who receive active compression-decompression cardiopulmonary resuscitation compared with standard CPR are more likely to have return of spontaneous circulation (NNT = 10 at unknown) .
  2. Patients given active compression-decompression CPR are more likely to be alive at seven days (NNT = 20 at 7 days) , and be discharged from hospital without neurological impairment (NNT = 27 at unknown) .
  3. Patients are more likely to be alive at one year (NNT = 37 at 12 months) .
Plaisance et al: New Engl J Med 1999; 341: 569-575
Expires October 2003

The study

Unblinded ?concealed quasi-randomised trial with intention-to-treat
Setting: 2 cities, France

750 patients (aged mean 58, 68% male) Suffered an out-of-hospital cardiac arrest and >18 years old

Excluded if
  • aged < 18
  • cardiac arrest was presumed to be irreversible (rigid body tone, pale colour, low body temperature and presence of presacral oedema)
  • do-not-resuscitate order
  • terminal illness
  • spontaneous palpable carotid or femoral pulse restored with basic life support alone
  • time from cardiac arrest to CPR >30mins


    • Control Group: (n = 377, 377 analysed): standard CPR (according to American Heart Association guidelines and European resuscitation Council guidelines)
    Experimental Group: (n = 373, 373 analysed): active compression-decompression CPR performed with Ambu CardioPump according to published recommendations

    100% followed for 12 months
    Outcome notes:
    • survival : at 24 hours
    • survival : at 7 days
    • survival to discharge without neurological impairment : using Glasgow-Pittsburgh cerebral-performance categories.
    • survival : at 12 months

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    return of spontaneous circulation unknown 111
    (29.4%)    		 146
    (39.1%)    		 33.0%
    (9% to 63%)    		 9.70%
    (2.94% to 16.46%)    		 10
    (6 to 34)
    survival 24 hours 51
    (13.5%)    		 85
    (22.8%)    		 68%
    (23% to 131%)    		 9.26%
    (3.78% to 14.7%)    		 11
    (7 to 26)
    survival 7 days 20
    (5.31%)    		 38
    (10.2%)    		 92%
    (14% to 224%)    		 4.88%
    (1.07% to 8.70%)    		 20
    (11 to 94)
    survival to discharge without neurological impairment unknown 7
    (1.86%)    		 21
    (5.63%)    		 200%
    (30% to 610%)    		 3.77%
    (1.07% to 6.48%)    		 27
    (15 to 94)
    survival 12 months 7
    (1.86%)    		 17
    (4.56%)    		 150%
    (3% to 485%)    		 2.70%
    (0.18% to 5.22%)    		 37
    (19 to 550)

    Comments

    1. The study is not large enough to show a difference between the two groups for survival at one year.
    2. CPR performed by physicians and crew of mobile intensive care units using Advanced Cardiac Life Support protocols.
    3. Note that compared to the UK, patients were only transferred to hospital if successfully resuscitated at the scene, patients were not resuscitated in a moving vehicle.
    4. All patients who survived to 12 months had witnessed cardiac arrests.

    Citation

    1. Plaisance P, et al: A comparison of standard cardiopulmonary resuscitation and active compression-decompression resuscitation for out-of-hospital cardiac arrest.. New Engl J Med 1999; 341: 569-575
    Contributor: Clare Wotton and Chris Ball, October 1999
    Reviewer: Malcolm Daniel

    Clinical Question.
    Patient suffering from an out-of-hospital cardiac arrest
    Intervention or Exposure active compression-decompression CPR versus standard CPR
    Outcome survival