Lurie K G, Shultz J J, Callaham M L, Schwab T M, Gisch T, Rector T, Frascone R J, Long L
Department of Medicine, Medical School, University of Minnesota-Minneapolis.
JAMA. 1994 May 11;271(18):1405-11.
OBJECTIVE--Active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) appears to improve ventilation and coronary perfusion when compared with standard CPR. The objective was to evaluate potential benefits of this new CPR technique in patients with out-of-hospital cardiac arrest in St Paul, Minn. DESIGN--Ten-month, prospective, randomized parallel-group design. SETTING--St Paul, Minn, population 270,000. PATIENTS--All normothermic victims of nontraumatic cardiac arrest older than 8 years who received CPR. MAIN OUTCOME MEASURES--Return of spontaneous circulation, admission to the intensive care unit (ICU), return of baseline neurological function (alert and oriented to person, place, and time), survival to hospital discharge, survival to hospital discharge with return of baseline neurological function, and complications. RESULTS--Seventy-seven patients received standard CPR and 53 patients received ACD CPR. The mean emergency medical services call response interval was less than 3.5 minutes. When all patients were considered, a higher percentage of ACD CPR patients had a return of spontaneous circulation and were admitted to the ICU vs standard CPR (45% vs 31%, and 40% vs 26%, respectively), but these trends were not statistically significant (P < .10 and P < .10). No statistically significant differences were found between hospital discharge rates (12 [23%] of 53 for ACD CPR vs 13 [17%] of 77 for standard CPR), return to baseline neurological function (10 [19%] of 53 for ACD CPR vs 13 [17%] of 77 for standard CPR), or return to baseline neurological function at hospital discharge (nine [17%] of 53 for ACD CPR vs 12 [16%] of 77 for standard CPR). Return of spontaneous circulation, ICU admission, and neurological recovery in both CPR groups were highly correlated with downtime (time from collapse to emergency medical system personnel arrival to the scene in witnessed arrests). With less than 10 minutes' downtime, survival to the ICU was 59% (19/32) with ACD CPR and 33% (16/49) with standard CPR (P < .02), return to baseline neurological function was 31% (10/32) with ACD CPR and 20% (10/49) with standard CPR (P = .27), and hospital discharge rate was 38% (12/32) with ACD CPR and 20% (10/49) with standard CPR (P = .17). Complication rates in patients admitted to the hospital were similar in both groups. CONCLUSIONS--This study demonstrates that ACD CPR appears to be more effective than standard CPR in a well-defined subset of victims of out-of-hospital cardiac arrest during the critical early phases of resuscitation. Based on this study, a larger study should be performed to evaluate the potential long-term benefits of ACD CPR.
目的——与标准心肺复苏术（CPR）相比，主动按压-减压（ACD）心肺复苏术似乎能改善通气和冠状动脉灌注。目的是评估这种新的心肺复苏技术对明尼苏达州圣保罗市院外心脏骤停患者的潜在益处。设计——为期10个月的前瞻性随机平行组设计。地点——明尼苏达州圣保罗市，人口27万。患者——所有接受心肺复苏术的8岁以上非创伤性心脏骤停的正常体温患者。主要观察指标——自主循环恢复、入住重症监护病房（ICU）、基线神经功能恢复（对人、地点和时间清醒且定向）、存活至出院、存活至出院且基线神经功能恢复以及并发症。结果——77例患者接受标准心肺复苏术，53例患者接受ACD心肺复苏术。平均紧急医疗服务呼叫响应间隔小于3.5分钟。当考虑所有患者时，与标准心肺复苏术相比，接受ACD心肺复苏术的患者自主循环恢复和入住ICU的比例更高（分别为45%对31%，40%对26%），但这些趋势无统计学意义（P<0.10和P<0.10）。在出院率（ACD心肺复苏术组53例中有12例[23%]，标准心肺复苏术组77例中有13例[17%]）、恢复至基线神经功能（ACD心肺复苏术组53例中有10例[19%]，标准心肺复苏术组77例中有13例[17%]）或出院时恢复至基线神经功能（ACD心肺复苏术组53例中有9例[17%]，标准心肺复苏术组77例中有12例[16%]）方面未发现统计学显著差异。两个心肺复苏术组的自主循环恢复、入住ICU和神经功能恢复均与停搏时间（从心脏停搏至紧急医疗系统人员到达现场的时间，在目击的心搏骤停中）高度相关。停搏时间少于10分钟时，接受ACD心肺复苏术的患者入住ICU的存活率为59%（19/32），接受标准心肺复苏术的患者为33%（16/49）（P<0.02），接受ACD心肺复苏术的患者恢复至基线神经功能的比例为31%（10/32），接受标准心肺复苏术的患者为20%（10/49）（P = 0.27），接受ACD心肺复苏术的患者出院率为38%（12/32），接受标准心肺复苏术的患者为20%（10/49）（P = 0.17）。两组入院患者的并发症发生率相似。结论——本研究表明，在院外心脏骤停患者复苏的关键早期阶段，在一个明确界定的亚组中，ACD心肺复苏术似乎比标准心肺复苏术更有效。基于本研究，应进行更大规模的研究以评估ACD心肺复苏术的潜在长期益处。
