Active compression-decompression cardiopulmonary resuscitation (CPR) versus standard CPR for cardiac arrest patients: a meta-analysis

Abstract

BACKGROUND: Active compression-decompression cardiopulmonary resuscitation (ACD-CPR) has been popular in the treatment of patients with cardiac arrest (CA). However, the effect of ACD-CPR versus conventional standard CPR (S-CRP) is contriversial. This study was to analyze the effi cacy and safety of ACD-CPR versus S-CRP in treating CA patients. METHODS:Randomized or quasi-randomized controlled trials published from January 1990 to March 2011 were searched with the phrase "active compression-decompression cardiopulmonary resuscitation and cardiac arrest" in PubMed, EmBASE, and China Biomedical Document Databases. The Cochrane Library was searched for papers of meta-analysis. Restoration of spontaneous circulation (ROSC) rate, survival rate to hospital admission, survival rate at 24 hours, and survival rate to hospital discharge were considered primary outcomes, and complications after CPR were viewed as secondary outcomes. Included studies were critically appraised and estimates of effects were calculated according to the model of fi xed or random effects. Inconsistency across the studies was evaluated using the I 2 statistic method. Sensitivity analysis was made to determine statistical heterogeneity. RESULTS:Thirteen studies met the criteria for this meta-analysis. The studies included 396 adult CA patients treated by ACD-CPR and 391 patients by S-CRP. Totally 234 CA patients were found out hospitals, while the other 333 CA patients were in hospitals. Two studies were evaluated with high-quality methodology and the rest 11 studies were of poor quality. ROSC rate, survival rate at 24 hours and survival rate to hospital discharge with favorable neurological function indicated that ACD-CPR is superior to S-CRP, with relative risk (RR) values of 1.39 (95% CI 0.99-1.97), 1.94 (95% CI 1.45-2.59) and 2.80 (95% CI 1. 60-5.24). No significant differences were found in survival rate to hospital admission and survival rate to hospital discharge for ACD-CPR versus S-CRP with RR values of 1.06 (95% CI 0.76-1.60) and 1.00 (95% CI 0.73-1.38).CONCLUSION: Quality controlled studies confirmed the superiority of ACD-CPR to S-CRP in terms of ROSC rate and survival rate at 24 hours. Compared with S-CRP, ACD-CPR could not improve survival rate to hospital admission or survival rate to hospital discharge.

Improving Survival From Cardiac Arrest: A Review of Contemporary Practice and Challenges

“…Mechanical devices designed to improve efficiency of chest compression have not consistently improved out-of-hospital cardiac arrest outcomes and are not recommended for routine use. [14][15][16][17] Failure of these devices to improve patient outcomes when applied broadly does not exclude a potential benefit during prolonged resuscitation or invasive procedures when rescuer fatigue could compromise quality of CPR.…”

The knowledge level of final year undergraduate health science students and medical interns about cardiopulmonary resuscitation at a university teaching hospital of Northwest Ethiopia

“…[12] The quality of cardiopulmonary resuscitation depends on the suffi ciency of the knowledge of health professionals and facilities. [13][14][15][16] Increasing survival of patients from cardiopulmonary arrest requires improvement in resuscitation education. [17][18][19][20][21][22][23][24] Studies conducted in Iran and New Zealand showed that the knowledge of interns and newly qualifi ed doctors were substandard.…”

The Development of Innovative Handheld Devices to Augment Cardiopulmonary Resuscitation Therapy and External Cardioversion and Defibrillation

“…The authors concluded that ACD CPR does not provide significant benefits over standard CPR. 16 Another meta-analysis by Wang et al suggested that the ACD CPR device is difficult to adhere to the patient's chest during resuscitation. 17 …”