Cardiac arrest: active compression-decompression does not reduce mortality

Clinical bottom line (level 1a)

  1. Patients with an cardiac arrest occurring in or out of hospital who received active compression-decompression cardiopulmonary resuscitation were not clearly less likely to survive or be discharged from hospital alive.
Lafuente-Lafuente and Melero-Bascones: Cochrane Library 2001; 3 : -
Expires June 2004

The study

Systematic review of all randomised or quasi-randomised controlled trials of
  • Patients: adults with a cardiac arrest
  • Intervention: active chest compression-decompression cardiopulmonary resuscitation compared with standard manual cardiopulmonary resuscitation
  • Outcome: death

Articles found in all languages using Cochrane Heart Group Specialised register, Cochrane Library, Medline, Embase, to April 2001 (search terms: detailed in text ) and checking reference lists of retrieved articles, searching 'related articles' in Pubmed and contacting companies manufacturing active decompression devices

Selection criteria: by 2 independent reviews with disagreements resolved by consensus
Appraisal criteria: by 2 independent reviewers with disagreements resolved by consensus: based on allocation concealment and randomisation
Articles excluded if:
  • resuscitation not performed by trained medical or paramedical team
  • patients aged < 16

10 studies found - 9 involving 4162 patients with out-of-hospital arrests, 2 involving 826 patients with inhospital arrests Study results were not found to be significantly heterogeneous.

The evidence

out-of-hospital cardiac arrest
Outcome Time to outcome CER OR
(95% CI)		 NNT
(95% CI)
immediate death minutes 1598/2137
(74.8%)		 0.91
(0.79 to 1.05) 		55
(NNT = 21 to infinity;
NNH = 110 to infinity)
death before hospital discharge days 1647/1760
(93.6%)		 0.91
(0.69 to 1.20) 		170
(NNT = 38 to infinity;
NNH = 99 to infinity)
neurological impairment days 20/170
(11.8%)		 1.96
(1.10 to 3.52) 		-11
(-97 to -5)

in-hospital cardiac arrest
Outcome Time to outcome CER OR
(95% CI)		 NNT
(95% CI)
immediate death minutes 258/396
(65.2%)		 0.94
(0.71 to 1.26) 		71
(NNT = 12 to infinity;
NNH = 20 to infinity)
death before hospital discharge days 351/396
(88.6%)		 1.01
(0.66 to 1.56) 		-1000
(NNT = 20 to infinity;
NNH = 27 to infinity)
neurological impairment days 14/135
(10.4%)		 1.27
(0.60 to 2.66) 		-41
(NNT = 26 to infinity;
NNH = 8 to infinity)

Citation

  1. Lafuente-Lafuente C, and Melero-Bascones M: active chest compression-decompression for cardiopulmonary resuscitation. Cochrane Library 2001; 3 : -
Search Terms: from ACP Journal Club other articles noted
Contributor: Chris Ball, June 2002
Reviewer:

Clinical Question.
Patient cardiac arrest
Intervention or Exposure active compression-decompression cardiopulmonary resuscitation
Comparison manual cardiopulmonary resuscitation
Outcome death