Does Active Chest Compression-Depression[ACD] CRP Improve Outcomes in Cardiac arrest?

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By Jonathan Leung, Consultant EM.

Active Chest Compression-Depression[ACD]devices:Do they decrease mortality or neurological impairment in Cardiac arrest?

BACKGROUND OF ACD DEVICE

ACD device = handheld device with a SUCTION CUP for perform of closed-chest cardiac massage
Difference to conventional CPR:-

  • Active Decompression of chest

  • Conventional CPR – Passive decompression

  • Change of intrathoracic pressure

  • Increase Venous return & Increase filling + Cardiac Output

 

SYSTEMATIC REVIEW OF USE OF ACD

Studies selection: 231 potential studies found. 10 met inclusion criteria :-

  • 8 = out of hospital trial

  • 1 = in-hospital trial

  • 1 = in and out of hospital trial

 

OUTCOME MEASURES

Studies, n                               Participants, n                                  RR (95% C.I)

Out of hospital cardiac arrest

Mortality at hospital discharge discharge

9                                              3412                                             0.99 [0.98-1.01]

Neurological impairment 

5                                               385                                              1.74 [1.06-2.85]

In-hospital cardiac arrest

Mortality at hospital discharge discharge 

2                                              826                                               1.00[0.95-1.05]

Neurological impairment

2                                             279                                                1.19[0.63-2.25]

 

CONCLUSION

  • No difference in mortality

  • Trend toward increase risk of Neurological impairment – OHCA

 

FUTURE

  • combination of impendance threshold device and ACD device is still not extensivey research

  • only one trial currently – OR – 1.58 [95% C.I – 1.07-2.36]- neurological favourable outcome

 

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