The Ontario trial of active compression-decompression cardiopulmonary resuscitation for in-hospital and prehospital cardiac arrest.

OBJECTIVE

To compare the impact of active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) and standard CPR on the outcomes of in-hospital and prehospital victims of cardiac arrest.

DESIGN

Randomized controlled trial with blinding of allocation using a sealed container.

SETTINGS

(1) Emergency departments, wards, and intensive care units of 5 university hospitals and (2) all locations outside hospitals in 2 midsized cities.

PATIENTS

A total of 1784 adults who had cardiac arrest.

INTERVENTION

Patients received either standard or ACD CPR throughout resuscitation.

MAIN OUTCOME MEASURES

Survival for 1 hour and to hospital discharge and the modified Mini-Mental State Examination (MMSE).

RESULTS

All characteristics were similar in the standard and ACD CPR groups for the 773 in-hospital patients and the 1011 prehospital patients. For in-hospital patients, there were no significant differences between the standard (n = 368) and ACD (n = 405) CPR groups in survival for 1 hour (35.1% vs 34.6%; P = .89), in survival until hospital discharge (11.4% vs 10.4%; P = .64), or in the median MMSE score of survivors (37 in both groups). For patients who collapsed outside the hospital, there were also no significant differences between the standard (n = 510) and ACD (n = 501) CPR groups in survival for 1 hour (16.5% vs 18.2%; P = .48), in survival to hospital discharge (3.7% vs 4.6%; P = .49), or in the median MMSE score of survivors (35 in both groups). Exploration of clinically important subgroups failed to identify any patients who appeared to benefit from ACD CPR.

CONCLUSIONS

ACD CPR did not improve survival or neurologic outcomes in any group of patients with cardiac arrest.