Active compression-decompression using a hand-held device for emergency heart massage

Lafuente-Lafuente C, Melero-Bascones M

Published Online:

October 6, 2010

During standard cardiopulmonary resuscitation (heart massage) for cardiac arrest (arrest of the heart) the chest is compressed manually and repeatedly by hand. This is a temporary method that pumps blood and oxygen to the brain via the heart. During standard cardiopulmonary resuscitation the chest is not manually decompressed. Active chest compression-decompression is an alternative method of heart massage and uses a hand held suction device to compress the chest then decompress the chest after each compression. Comparison of these techniques showed active chest compression-decompression to have no advantage for patients and had some drawbacks compared to standard cardiopulmonary resuscitation

Abstract (click to read)

Background:

Active compression-decompression cardiopulmonary resuscitation (ACDR CPR) uses a hand-held suction device, applied mid-sternum, to compress the chest then actively decompress the chest after each compression. Randomised controlled trials testing this device have shown discordant results.

Objectives:

To determine clinical effects and safety of active compression-decompression cardiopulmonary resuscitation compared with standard manual cardiopulmonary resuscitation (STR).

Search strategy:

We searched the Cochrane Central Register of Controlled Trials, Issue 2 2010, MEDLINE (1966 to June 2010) and EMBASE (1980 to June 2010). We checked the reference list of retrieved articles, contacted experts in the field and searched ClinicalTrials.gov.

Selection criteria:

All randomised or quasi-randomised studies comparing active compression-decompression with standard manual chest compression, in adults with a cardiac arrest who received cardiopulmonary resuscitation by a trained medical or paramedical team.

Data collection and analysis:

Data were independently extracted, on an intention-to-treat basis. The authors of the primary studies were contacted when needed. Studies were cumulated, if appropriate, and pooled relative risk (RR) estimated. Subgroup analysis according to setting (out of hospital or in hospital) and attending team composition (with physician or paramedic only) were predefined.

Main results:

In this update, eight new related publications were found but they did not fulfil inclusion criteria or concerned patients already reported in other publications. Ten trials are included: eight were in out-of-hospital settings, one set in-hospital only and one had both in-hospital and out-of-hospital components. Allocation concealment was adequate in four studies. The two in-hospital studies were different in quality and size (773 and 53 patients). Both found no differences between ACDR CPR and STR in any outcome.

Out-of-hospital trials cumulated 4162 patients. There were no differences between ACDR CPR and STR for mortality either immediately (RR 0.98, 95% CI 0.94 to 1.03) or at hospital discharge (RR 0.99, 95%CI 0.98 to 1.01). The pooled RR of neurological impairment, any severity, was 1.71 (95%CI 0.90 to 3.25), with a non-significant trend to more frequent severe neurological damage in survivors of ACDR CPR (RR 3.11, 95% CI 0.98 to 9.83). However, assessment of neurological outcome was limited and few patients had neurological damage.

There was no difference between ACDR CPR and STR with regard complications such as rib or sternal fractures, pneumothorax or haemothorax (RR 1.09, 95% CI 0.86 to 1.38). Skin trauma and ecchymosis were more frequent with ACDR CPR.

Authors' conclusions:

Active chest compression-decompression in patients with cardiac arrest is not associated with clear benefit.

This record should be cited as:

Lafuente-Lafuente C, Melero-Bascones M. Active chest compression-decompression for cardiopulmonary resuscitation. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD002751. DOI: 10.1002/14651858.CD002751.pub2

Assessed as up to date:

June 29, 2010

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Primary Review Group:

Heart Group

Health topics:

Heart & circulation > Cardiac arrest

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Active compression-decompression using a hand-held device for emergency heart massage

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