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

Per Olav Berve; Bjarne Madsen Hardig; Tore Skålhegg; Håvard Kongsgaard; Jo Kramer-Johansen; Lars Wik

doi:10.1016/j.resuscitation.2021.10.026

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

Resuscitation. 2022 Jan:170:1-10. doi: 10.1016/j.resuscitation.2021.10.026. Epub 2021 Oct 25.

Authors

Per Olav Berve¹, Bjarne Madsen Hardig², Tore Skålhegg³, Håvard Kongsgaard⁴, Jo Kramer-Johansen⁵, Lars Wik⁶

Affiliations

¹ Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway; Air Ambulance Department, Division of Prehospital Services, Oslo University Hospital, Oslo, Norway; Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway. Electronic address: peolbe@ous-hf.no.
² Clinical Sciences, Helsingborg, Section II, Faculty of Medicine, Lund University, Sweden; Stryker/Jolife AB, Lund, Sweden.
³ Air Ambulance Department, Division of Prehospital Services, Oslo University Hospital, Oslo, Norway.
⁴ Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway.
⁵ Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway; Air Ambulance Department, Division of Prehospital Services, Oslo University Hospital, Oslo, Norway.
⁶ Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway; Air Ambulance Department, Division of Prehospital Services, Oslo University Hospital, Oslo, Norway; Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway.

PMID: 34710550
DOI: 10.1016/j.resuscitation.2021.10.026

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 (p_MTCO₂) 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 p_MTCO₂: 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.

Keywords: ACD-CPR; Active compression decompression; Capnography; Cardiac arrest; Cardiopulmonary resuscitation; Cerebral oximetry; ETCO(2); Haemodynamic; Invasive arterial blood pressure; Mechanical chest compression; NIRS; SctO(2); rSO(2).

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cardiopulmonary Resuscitation* / methods
Decompression
Hemodynamics
Humans
Out-of-Hospital Cardiac Arrest* / therapy
Prospective Studies
Thoracic Wall*

Associated data

ClinicalTrials.gov/NCT02479152