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Mechanical active compression-decompression versus standard mechanical cardiopulmonary resuscitation : A randomised haemodynamic out-of-hospital cardiac arrest study

Berve, Per Olav ; Hardig, Bjarne Madsen LU ; Skålhegg, Tore ; Kongsgaard, Håvard ; Kramer-Johansen, Jo and Wik, Lars (2022) In Resuscitation 170. p.1-10
Abstract

Background: Active compression-decompression cardiopulmonary resuscitation (ACD-CPR) utilises a suction cup to lift the chest-wall actively during the decompression phase (AD). We hypothesised that mechanical ACD-CPR (Intervention), with AD up to 30 mm above the sternal resting position, would generate better haemodynamic results than standard mechanical CPR (Control). Methods: This out-of-hospital adult non-traumatic cardiac arrest trial was prospective, block-randomised and non-blinded. We included intubated patients with capnography recorded during mechanical CPR. Exclusion criteria were pregnancy, prisoners, and prior chest surgery. The primary endpoint was maximum tidal carbon dioxide partial pressure (pMTCO2)... (More)

Background: Active compression-decompression cardiopulmonary resuscitation (ACD-CPR) utilises a suction cup to lift the chest-wall actively during the decompression phase (AD). We hypothesised that mechanical ACD-CPR (Intervention), with AD up to 30 mm above the sternal resting position, would generate better haemodynamic results than standard mechanical CPR (Control). Methods: This out-of-hospital adult non-traumatic cardiac arrest trial was prospective, block-randomised and non-blinded. We included intubated patients with capnography recorded during mechanical CPR. Exclusion criteria were pregnancy, prisoners, and prior chest surgery. The primary endpoint was maximum tidal carbon dioxide partial pressure (pMTCO2) and secondary endpoints were oxygen saturation of cerebral tissue (SctO2), invasive arterial blood pressures and CPR-related injuries. Intervention device lifting force performance was categorised as Complete AD (≥30 Newtons) or Incomplete AD (≤10 Newtons). Haemodynamic data, analysed as one measurement for each parameter per ventilation (Observation Unit, OU) with non-linear regression statistics are reported as mean (standard deviation). A two-sided p-value < 0.05 was considered as statistically significant. Results: Of 221 enrolled patients, 210 were deemed eligible (Control 109, Intervention 101). The Control vs. Intervention results showed no significant differences for pMTCO2: 29(17) vs 29(18) mmHg (p = 0.86), blood pressures during compressions: 111(45) vs. 101(68) mmHg (p = 0.93) and decompressions: 21(20) vs. 18(18) mmHg (p = 0.93) or for SctO2%: 55(36) vs. 57(9) (p = 0.42). The 48 patients who received Complete AD in > 50% of their OUs had higher SctO2 than Control patients: 58(11) vs. 55(36)% (p < 0.001). Conclusions: Mechanical ACD-CPR provided similar haemodynamic results to standard mechanical CPR. The Intervention device did not consistently provide Complete AD. Clinical trial registration: ClinicalTrials.gov identifier (NCT number): NCT02479152. The Haemodynamic Effects of Mechanical Standard and Active Chest Compression-decompression During Out-of-hospital CPR.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
ACD-CPR, Active compression decompression, Capnography, Cardiac arrest, Cardiopulmonary resuscitation, Cerebral oximetry, ETCO, Haemodynamic, Invasive arterial blood pressure, Mechanical chest compression, NIRS, rSO, SctO
in
Resuscitation
volume
170
pages
10 pages
publisher
Elsevier
external identifiers
  • scopus:85119301319
  • pmid:34710550
ISSN
0300-9572
DOI
10.1016/j.resuscitation.2021.10.026
language
English
LU publication?
yes
id
f33f9d67-e61d-43bf-8a24-19ae44795ffc
date added to LUP
2021-12-08 14:06:55
date last changed
2024-08-11 03:00:59
@article{f33f9d67-e61d-43bf-8a24-19ae44795ffc,
  abstract     = {{<p>Background: Active compression-decompression cardiopulmonary resuscitation (ACD-CPR) utilises a suction cup to lift the chest-wall actively during the decompression phase (AD). We hypothesised that mechanical ACD-CPR (Intervention), with AD up to 30 mm above the sternal resting position, would generate better haemodynamic results than standard mechanical CPR (Control). Methods: This out-of-hospital adult non-traumatic cardiac arrest trial was prospective, block-randomised and non-blinded. We included intubated patients with capnography recorded during mechanical CPR. Exclusion criteria were pregnancy, prisoners, and prior chest surgery. The primary endpoint was maximum tidal carbon dioxide partial pressure (p<sub>MT</sub>CO<sub>2</sub>) and secondary endpoints were oxygen saturation of cerebral tissue (SctO<sub>2</sub>), invasive arterial blood pressures and CPR-related injuries. Intervention device lifting force performance was categorised as Complete AD (≥30 Newtons) or Incomplete AD (≤10 Newtons). Haemodynamic data, analysed as one measurement for each parameter per ventilation (Observation Unit, OU) with non-linear regression statistics are reported as mean (standard deviation). A two-sided p-value &lt; 0.05 was considered as statistically significant. Results: Of 221 enrolled patients, 210 were deemed eligible (Control 109, Intervention 101). The Control vs. Intervention results showed no significant differences for p<sub>MT</sub>CO<sub>2</sub>: 29(17) vs 29(18) mmHg (p = 0.86), blood pressures during compressions: 111(45) vs. 101(68) mmHg (p = 0.93) and decompressions: 21(20) vs. 18(18) mmHg (p = 0.93) or for SctO<sub>2</sub>%: 55(36) vs. 57(9) (p = 0.42). The 48 patients who received Complete AD in &gt; 50% of their OUs had higher SctO<sub>2</sub> than Control patients: 58(11) vs. 55(36)% (p &lt; 0.001). Conclusions: Mechanical ACD-CPR provided similar haemodynamic results to standard mechanical CPR. The Intervention device did not consistently provide Complete AD. Clinical trial registration: ClinicalTrials.gov identifier (NCT number): NCT02479152. The Haemodynamic Effects of Mechanical Standard and Active Chest Compression-decompression During Out-of-hospital CPR.</p>}},
  author       = {{Berve, Per Olav and Hardig, Bjarne Madsen and Skålhegg, Tore and Kongsgaard, Håvard and Kramer-Johansen, Jo and Wik, Lars}},
  issn         = {{0300-9572}},
  keywords     = {{ACD-CPR; Active compression decompression; Capnography; Cardiac arrest; Cardiopulmonary resuscitation; Cerebral oximetry; ETCO; Haemodynamic; Invasive arterial blood pressure; Mechanical chest compression; NIRS; rSO; SctO}},
  language     = {{eng}},
  pages        = {{1--10}},
  publisher    = {{Elsevier}},
  series       = {{Resuscitation}},
  title        = {{Mechanical active compression-decompression versus standard mechanical cardiopulmonary resuscitation : A randomised haemodynamic out-of-hospital cardiac arrest study}},
  url          = {{http://dx.doi.org/10.1016/j.resuscitation.2021.10.026}},
  doi          = {{10.1016/j.resuscitation.2021.10.026}},
  volume       = {{170}},
  year         = {{2022}},
}