CPR with Active Compression-Decompression and Negative Intrathoracic Pressure May Improve Survival in Adults with Nontraumatic Cardiac Arrest

DynaMed Weekly Update - Volume 6, Issue 4

Standard cardiopulmonary resuscitation (CPR) can be a life-saving first response for cardiac arrest, but it does not efficiently supply blood to the heart and brain, and survival rates can be low. One method to improve the efficiency of CPR is active compression-decompression (ACD), a mechanically-aided approach using a hand-held suction cup device to provide full chest decompression. As part of recent updating of CPR guidelines, ILCOR and AHA found insufficient evidence to recommend for or against the routine use of ACD, but the AHA stated that it could be used if performed by adequately trained providers (Circulation 2010 Oct 19;122(16 Suppl 2):S338; Circulation 2010 Nov 2;122(18 Suppl 3):S720). The RESQ randomized trial evaluated an augmented form of ACD-CPR in 2,470 adults with out-of-hospital nontraumatic cardiac arrest who were treated by emergency medical service personnel. In the intervention group, patients received ACD with compression frequency and depth controlled by a metronome and force gauge. ACD was augmented with an impedance-threshold device connected to a facemask or advanced airway used to provide negative intrathoracic pressure. Negative pressure increases cerebral perfusion by reducing pressure during decompression. Patients in the control group received standard manual CPR. Patients were excluded for noncardiac causes of arrest including respiratory, hemorrhagic and metabolic etiologies.

In an analysis of 1,653 patients who met final inclusion criteria, active compression-decompression CPR plus negative intrathoracic pressure was associated with a higher rate of survival to hospital discharge (9% vs. 6%, p = 0.019, NNT 34) and increased 1-year survival (9% vs. 6%, (p = 0.03, NNT 34) (level 2 [mid-level] evidence). Rates of pulmonary edema were increased in the active compression group (11% vs. 7%, p = 0.015, NNH 25). At 1-year follow-up, there were no significant differences in cognitive skills, disability ratings or emotional/psychological status (Lancet 2011 Jan 22;377(9762):301).

For more information, see the Cardiac arrest topic in DynaMed.