Lafuente-Lafuente C, Melero-Bascones M
Area de Urgencias, Clínica Moncloa, Avda. Valladolid, 83, Madrid, Spsin, 28008.
Cochrane Database Syst Rev. 2001(3):CD002751. doi: 10.1002/14651858.CD002751.
Active compression-decompression cardiopulmonary resuscitation (ACD 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 on use of active compression decompression cardiopulmonary resuscitation have results which are discordant.
To determine clinical effects and safety of active compression-decompression cardiopulmonary resuscitation compared with standard manual cardiopulmonary resuscitation (STR).
We searched the Cochrane Heart Group Specialised register (April 2001), the Cochrane library, MEDLINE and EMBASE. We checked the reference list of retrieved articles and contacted enterprises manufacturing the active decompression devices.
All randomized or quasi-randomized studies comparing active compression-decompression cardiopulmonary resuscitation compared with standard manual cardiopulmonary resuscitation in adults with a cardiac arrest who received cardiopulmonary resuscitation by a trained medical or paramedical team.
Data were independently extracted. All data were analysed on an intention-to-treat basis. The authors of the primary studies were contacted for more information 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.
Twelve trials were included: 10 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 4 trials. The two in-hospital studies were very different in quality (A and C) and size (773 and 53 patients). Both found no differences between ACD CPR and STR in any outcome. Trials conducted in out-of-hospital settings cumulated 4162 patients. There were no differences between ACD CPR and STR for mortality either immediately (RR 0.98 [95% CI 0.94 - 1.03]) or at hospital discharge (RR 0.99 [95% CI 0.98 - 1.01]). The pooled RR of neurological impairment, any severity, was 1.71 [95% CI 0.90 - 3.25], with a non-significant trend to more frequent severe neurological damage in survivors of ACD CPR (RR 3.11 [95% CI 0.98 - 9.83]). However, assessment of neurological outcome was limited and there were few patients with neurological damage. There was no difference between ACD CPR and STR with regard complications such as rib or sternal fractures, pneumothorax or hemothorax (RR 1.09 [95% CI 0.86 - 1.38]). Skin trauma and ecchymosis were more frequent with ACD CPR.
REVIEWER'S CONCLUSIONS: Active chest compression-decompression in patients with cardiac arrest is not associated with clear benefit.
主动按压-减压心肺复苏术（ACD CPR）使用手持式吸引装置，置于胸骨中部，用于按压胸部，然后在每次按压后主动放松胸部。关于主动按压-减压心肺复苏术的随机对照试验结果不一致。
确定与标准徒手心肺复苏术（STR）相比，主动按压-减压心肺复苏术的临床效果和安全性。
我们检索了Cochrane心脏组专业注册库（2001年4月）、Cochrane图书馆、MEDLINE和EMBASE。我们检查了检索到的文章的参考文献列表，并联系了生产主动减压装置的企业。
所有比较主动按压-减压心肺复苏术与标准徒手心肺复苏术的随机或半随机研究，研究对象为心脏骤停的成年人，由训练有素的医疗或护理团队进行心肺复苏。
数据由独立人员提取。所有数据均按照意向性分析原则进行分析。必要时联系主要研究的作者以获取更多信息。如有合适的研究，进行累积分析，并估计合并相对风险（RR）。根据环境（院外或院内）和参与团队组成（仅由医生或护理人员参与）进行亚组分析是预先设定的。
纳入了12项试验：10项在院外环境中进行，1项仅在院内进行，1项既有院内部分也有院外部分。4项试验的分配隐藏充分。两项院内研究在质量（A和C）和规模（773例和53例患者）上差异很大。两项研究均未发现ACD CPR和STR在任何结局上存在差异。在院外环境中进行的试验共纳入4162例患者。ACD CPR和STR在即刻死亡率（RR 0.98 [95%CI 0.94 - 1.03]）或出院时死亡率（RR 0.99 [95%CI 0.98 - 1.01]）方面均无差异。任何严重程度的神经功能障碍的合并RR为1.71 [95%CI 0.90 - 3.25]，ACD CPR幸存者中出现更频繁严重神经损伤的趋势不显著（RR 3.11 [95%CI 0.98 - 9.83]）。然而，神经功能结局的评估有限，且神经损伤患者较少。ACD CPR和STR在肋骨或胸骨骨折气胸或血胸等并发症方面无差异（RR 1.09 [95%CI 0.86 - 1.38]）。ACD CPR导致的皮肤创伤和瘀斑更常见。
心脏骤停患者进行主动胸部按压-减压并无明显益处。
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