Active compression-decompression cardiopulmonary resuscitation (CPR) versus standard CPR for cardiac arrest patients: a meta-analysis

doi:10.5847/wjem.j.issn.1920-8642.2013.04.004

Abstract

Abstract:

BACKGROUND: Active compression-decompression cardiopulmonary resuscitation (ACD-CPR) has been popular in the treatment of patients with cardiac arrest (CA). However, the effect of ACD-CPR versus conventional standard CPR (S-CRP) is contriversial. This study was to analyze the efficacy and safety of ACD-CPR versus S-CRP in treating CA patients.
METHODS: Randomized or quasi-randomized controlled trials published from January 1990 to March 2011 were searched with the phrase "active compression-decompression cardiopulmonary resuscitation and cardiac arrest" in PubMed, EmBASE, and China Biomedical Document Databases. The Cochrane Library was searched for papers of meta-analysis. Restoration of spontaneous circulation (ROSC) rate, survival rate to hospital admission, survival rate at 24 hours, and survival rate to hospital discharge were considered primary outcomes, and complications after CPR were viewed as secondary outcomes. Included studies were critically appraised and estimates of effects were calculated accordingto the model of fixed or random effects. Inconsistency across the studies was evaluated using the I² statistic method. Sensitivity analysis was made to determine statistical heterogeneity.
RESULTS: Thirteen studies met the criteria for this meta-analysis. The studies included 396 adult CA patients treated by ACD-CPR and 391 patients by S-CRP. Totally 234 CA patients were found out hospitals, while the other 333 CA patients were in hospitals. Two studies were evaluated with high-quality methodology and the rest 11 studies were of poor quality. ROSC rate, survival rate at 24 hours and survival rate to hospital discharge with favorable neurological function indicated that ACD-CPR is superior to S-CRP, with relative risk (RR) values of 1.39 (95% CI 0.99-1.97), 1.94 (95% CI 1.45-2.59) and 2.80 (95% CI 1.60-5.24). No significant differences were found in survival rate to hospital admission and survival rate to hospital discharge for ACD-CPR versus S-CRP with RR values of 1.06 (95% CI 0.76-1.60) and 1.00 (95% CI 0.73-1.38).
CONCLUSION: Quality controlled studies confirmed the superiority of ACD-CPR to S-CRP in terms of ROSC rate and survival rate at 24 hours. Compared with S-CRP, ACD-CPR could not improve survival rate to hospital admission or survival rate to hospital discharge.

Key words: Active compression-decompression, Cardiopulmonary resuscitation, Cardiac arrest, Meta-analysis

Xu-rui Luo, Hui-li Zhang, Geng-jin Chen, Wen-shu Ding, Liang Huang. Active compression-decompression cardiopulmonary resuscitation (CPR) versus standard CPR for cardiac arrest patients: a meta-analysis[J]. World Journal of Emergency Medicine, 2013, 4(4): 266-272.

Figures/Tables 7

Figure 1.

Table 1

General information about included studies

Author	Patients (T/C)	Age	Treatment (T/C)	Outcome	Circumstances where patients confronted CA	Country
2009 Chen SP	109/109	≥18	T: ACD-CPR C: standard CRP	ROSC Survival rate at 24 hours	Out-of-hospital	China
2003 He Q	46/46	≥18	T: ACD-CPR C: standard CRP	ROSC Survival rate to hospital admission	In-hospital	China
1999 Baubin M	33/15	≥18	T1: ACD-CPR C: standard CRP	Ventricular fibrillation Complications of CPR (sternal fractures)	Out-of-hospital	Australia
1999 Plaisance P	373/377	≥18	T: ACD-CPR C: standard CRP	Hospital discharge rate without neurologic impairment One-year survival rate	Out-of-hospital	France
1997 Mauer D	-	≥18	T: ACD-CPR C: standard CRP	Survival rate Neurological outcome Complications of CPR	Out-of-hospital	Germany
1997 Plaisance P	254/258	≥18	T: ACD-CPR C: standard CRP	ROSC Survival rate at 1 hour, 24 hours, and 1 month Survival rate to hospital discharge without neurological impairment Neurological outcome Complications of CPR	Out-of-hospital	France
1996 Luiz T	26/30	≥18	T: ACD-CPR C: standard CRP	ROSC Mean carbon dioxide content	Out-of-hospital	Germany
1996 Mauer D	106/114	≥18	T: ACD-CPR C: standard CRP	ROSC Survival rate to hospital admission Survival rate to hospital discharge Neurological outcome (CPC and OPC) Complications of CPR	Out-of-hospital	Germany
1996 Stiell IG	405/368	≥18	T: ACD-CPR C: standard CRP	Survival rate to hospital discharge Neurological outcome	In-hospital	Canada
1996 Stiell IG	501/510	≥18	T: ACD-CPR C: standard CRP	Survival rate to hospital discharge Neurological outcome	Out-of-hospital	Canada
1994 Ellinger K	26/30	≥18	T: ACD-CPR C: standard CRP	ROSC Survival rate to hospital discharge Complications of CPR	Out-of-hospital	Germany
1994 Tucker KJ	25/28	≥18	T: ACD-CPR C: standard CRP	ROSC Survival rate at 24 hours Surivival rate to hospital discharge	In-hospital	USA
1993 Cohen TJ	29/33	≥18	T: ACD-CPR C: standard CRP	Rages of initial resuscitation Survival rate at 24 hours Survival rate to hospital discharge Neurological outcome	In-hospital	USA

Table 1

Table 2

Figure 2.

Figure 3.

Figure 4.

Figure 5.

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