Published Online
on October 20, 2003

A more recent version of this article appeared on November 4, 2003

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Submitted on July 14, 2003
Revised on August 8, 2003
Accepted on August 13, 2003

Comparison of Standard Cardiopulmonary Resuscitation Versus the Combination of Active Compression-Decompression Cardiopulmonary Resuscitation and an Inspiratory Impedance Threshold Device for Out-of-Hospital Cardiac Arrest

Benno B. Wolcke MD, Dietmar K. Mauer MD, PhD, Mark F. Schoefmann MD, Heinke Teichmann MD, Terry A. Provo BA, Karl H. Lindner MD, PhD, Wolfgang F. Dick MD, PhD, Dorothee Aeppli PhD, and Keith G. Lurie MD^*

From the Johannes Gutenberg University Medical School, Clinic of Anesthesiology, Mainz, Germany (B.B.W., D.K.M., M.F.S., H.T., W.F.D.); the Department of Anesthesia and Intensive Care Medicine, Leopold-Franzens Institute, Innsbruck, Austria (K.H.L.); Advanced Circulatory Systems Inc, Eden Prairie, Minn (T.A.P., K.G.L.); and the Division of Biostatistics (D.A.), School of Public Health, and Department of Emergency Medicine (K.G.L.), University of Minnesota, and Hennepin County Medical Center, Minneapolis.

^* To whom correspondence should be addressed. E-mail: lurie002{at}tc.umn.edu.

Background--Active compression-decompression (ACD) CPR combined with an inspiratory impedance threshold device (ITD) improves vital organ blood flow during cardiac arrest. This study compared survival rates with ACD+ITD CPR versus standard manual CPR (S-CPR).

Methods and Results--A prospective, controlled trial was performed in Mainz, Germany, in which a 2-tiered emergency response included early defibrillation. Patients with out-of-hospital arrest of presumed cardiac pathogenesis were sequentially randomized to ACD+ITD CPR or S-CPR by the advanced life support team after intubation. Rescuers learned which method of CPR to use at the start of each work shift. The primary end point was 1-hour survival after a witnessed arrest. With ACD+ITD CPR (n=103), return of spontaneous circulation and 1- and 24-hour survival rates were 55%, 51%, and 37% versus 37%, 32%, and 22% with S-CPR (n=107) (P=0.016, 0.006, and 0.033, respectively). One- and 24-hour survival rates in witnessed arrests were 55% and 41% with ACD+ITD CPR versus 33% and 23% in control subjects (P=0.011 and 0.019), respectively. One- and 24-hour survival rates in patients with a witnessed arrest in ventricular fibrillation were 68% and 58% after ACD+ITD CPR versus 27% and 23% after S-CPR (P=0.002 and 0.009), respectively. Patients randomized 10 minutes after the call for help to the ACD+ITD CPR had a 3 times higher 1-hour survival rate than control subjects (P=0.002). Hospital discharge rates were 18% after ACD+ITD CPR versus 13% in control subjects (P=0.41). In witnessed arrests, overall neurological function trended higher with ACD+ITD CPR versus control subjects (P=0.07).

Conclusions--Compared with S-CPR, ACD+ITD CPR significantly improved short-term survival rates for patients with out-of-hospital cardiac arrest. Additional studies are needed to evaluate potential long-term benefits of ACD+ITD CPR.

Key words: cardiac arrest • cardiopulmonary resuscitation • treatment

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