Cardiac Arrest: interposed abdominal counterpulsation during cardiopulmonary resuscitation increased survival.

Clinical bottom line (level 1b)

  1. Patient who have an cardiac arrest in hospital who received interposed abdominal counterpulsation during cardiopulmonary resuscitation were more likely to have a spontaneous return of circulation (NNT = 3 at 3 minutes)
  2. Patients are more likely to be alive at 24 hours (NNT = 5 at 24 hours)
  3. Patients are more likely to be alive at discharge (NNT = 6 at unknown)
Sack et al: JAMA 1992; 267 (3): 379-385
Expires October 2003

The study

Single-blinded ?concealed randomised trial with intention-to-treat
Setting: medical and surgical wards, ITU and CCU, acute hospital, USA

103 patients (aged 22 to 91; mean 65, 54% male) with a primary cardiac arrest (unresponsive, apneic and pulseless)

Excluded if
  • do not resuscitate order in place
  • cardiopulmonary arrest secondary to trauma
  • primary respiratory arrest
  • history or signs consistent with abnormal aortic aneurysm
  • age <18 years
  • suspected pregnancy
  • return of spontaneous circulation prior to arrival of CPR team

Note:

  • CPR was performed by internal medicine residents using advanced cardiac life support protocols.


Control Group: (n = 55, 55 analysed): cardiopulmonary resuscitation at 80 compressions to 100 per minutes
Experimental Group: (n = 48, 48 analysed): interposed abdominal compression over the umbilicus to co-ordinate with early relaxation of chest compression (rate 80 to 100 per minute)
CPR was considered successful if there was return of spontaneous circulation defined by the presence of a palpable femoral arterial pulse and a systole blood pressure >80mmHg for >3 mins.
100% followed for 24 hours
Outcome notes:
  • return of spontaneous circulation : a palpable femoral arterial pulse and a systolic bp >80 mmHg for longer than 3 minutes
  • neurologically intact : normal or confused but able to do some self-care

The evidence

Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
return of spontaneous circulation 3 minutes 14
(25.5%)		 29
(60.4%)		 137%
(43% to 294%)		 35.0%
(17.0% to 53.0%)		 3
(2 to 6)
survival 24 hours 7
(12.7%)		 16
(33.3%)		 162%
(18% to 483%)		 20.6%
(4.62% to 36.6%)		 5
(3 to 22)
survival to discharge unknown 4
(7.27%)		 12
(25.0%)		 244%
(19% to 895%)		 17.7%
(3.69% to 31.8%)		 6
(3 to 27)
neurologically intact unknown 3
(5.45%)		 8
(16.7%)		 206%
(-14% to 987%)		 11.2%
(-0.92% to 23.3%)		 9
(NNT = 109 to infinity;
NNH = 4 to infinity)

Comments

  1. Internal medicine residents performed CPR using Advanced Cardiac Life Support protocols.
  2. Chest compressions were not standardised throughout the study.

Citation

  1. Sack JB, Kesselbrenner MB, Bregman D: Survival from in-hospital cardiac arrest with interposed abdominal counterpulsation during cardiopulmonary resuscitation. JAMA 1992; 267 (3): 379-385
Contributor: Clare Wotton, Unknown Month 1999
Reviewer: Chris Ball

Clinical Question.
Patient Suffering from in-hospital cardiac arrest
Intervention or Exposure interposed abdominal counterpulsation CPR
Comparison CPR
Outcome survival