409 No clear benefit from active chest compression-decompression compared with standard manual CPR

April 05, 2014

PEARLS 409, October 2013, written by Brian R McAvoy

Clinical question
How effective is active chest compression-decompression cardiopulmonary resuscitation (ACDR CPR) in adults with cardiac arrest?

Bottom line
There was no clear evidence of benefits from the use of ACDR CPR compared with standard manual CPR in people with cardiac arrest occurring in different settings and different emergency medical systems. There were no differences between ACDR CPR and standard manual CPR for mortality (immediate or at hospital discharge), severity of neurological impairment or complications, such as rib or sternal fracture, pneumothorax or haemothorax. Skin trauma and ecchymosis were more frequent with ACDR CPR.

Caveat
Eight studies were in out-of-hospital settings, one was set in-hospital only and one had both in-hospital and out-ofhospital components. Assessment of neurological outcomes was limited, and few participants had neurological damage.

Context
During standard CPR for cardiac arrest, the chest is compressed manually and repeatedly by hand. During standard CPR the chest is not manually decompressed. ACDR CPR uses a hand-held suction device, applied midsternum, to compress the chest then actively decompress the chest after each compression.

Cochrane Systematic Review
Lafuente-Lafuente C, Melero-Bascones M. Active chest compression-decompression for cardiopulmonary resuscitation. Cochrane Reviews, 2013, Issue 9. Art. No.: CD002751.DOI: 10.1002/14651858. CD002751.pub3. This review contains 10 studies involving 4988 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.