a b s t r a c t

Background: Despite all of the studies conducted on cardiopulmonary resuscitation (CPR), the mortality rate of cardiac arrest patients is still high. This has led to a search for Alternative methods. One of these methods is active compression-decompression CPR (ACD-CPR) performed with the CardioPump.

Objective: The differences in the restoration of spontaneous circulation; the 1-, 7-, and 30-day survival rates; and hospital discharge rates between conventional CPR and ACD-CPR performed with CardioPump were investigat- ed. In addition, the differences between the 2 methods with respect to complications were also investigated.

Methods: Our study was a prospective, randomized medical device study with a case-control group. Cardiac arrest cases brought to our emergency medicine clinic by the 112 emergency ambulances from out of hospital and pa- tients who had developed cardiac arrest inhospital clinics between April 2015 and September 2015 were includ- ed in our study. For randomization, standard CPR was performed on odd days of each month, and CPR using CardioPump was performed on the even days of each month.

Results: A total of 181 patients were included in our study. The number of patients who received conventional CPR was determined as 86 (47.5%), and the number of patients who received CPR using the CardioPump was de- termined as 95 (52.5%). We did not identify any difference between conventional CPR and CardioPump ACD-CPR with respect to restoration of spontaneous circulation, discharge rates, and the 1-, 7-, and 30-day survival rates. (P = .384, P = .601, P = .997, P = .483, and P = .803, respectively) The complication rate was higher in the pa- tient group that received conventional CPR (P b .001).

Conclusion: As a result of our study, we did not obtain any evidence supporting the replacement of conventional CPR with ACD-CPR performed using CardioPump.

(C) 2015

? Conflict of interest: No conflict of interest was declared by the authors.

?? Financial support: Any financial support is not used.

? The study protocol was approved by the local ethics committee and Republic of Turkey

Ministry of Health Medical Devices and Drug Administration and conducted in accordance with the Declaration of Helsinki and Good Clinical Practices.

* Corresponding author at: Department of Emergency Medicine, Konya Training and Re- search Hospital, Haci Saban Mah, Meram Yeniyol Caddesi No:97 PK: 42090 Meram, Konya, Turkey. Tel.: +90 505 8658089.

E-mail addresses: [email protected] (Y.K. Gunaydin), [email protected]

(B. Cekmen), [email protected] (N.B. Akilli), [email protected] (R. Koylu), [email protected] (E.T. Sert), [email protected] (B. Cander).

¹ Contribution: Design and writing of the study.

² Contribution: Collection of cases to writing the study form.

³ Tel.: +90 541 6817798.

⁴ Contribution: Making statistics.

⁵ Tel.: +90 505 5377520.

⁶ Contribution: Reviewing and editing the study.

⁷ Tel.: +90 505 9202035.

⁸ Tel.: +90 506 5585705.

⁹ Tel.: +90 533 3445339

Introduction

Inhospital and out-of-hospital cardiac arrests are situations that have quite high mortality rates [1,2]. The survival rates vary between 5% and 50% [3]. Various degrees of brain damage develop in more than half of the survivors [4,5]. (See Fig.)

The most important goal of cardiopulmonary resuscitation (CPR) is the return of spontaneous circulation (ROSC). This is achieved with hand compressions during CPR. During compression, the intrathoracic pressure rises, and blood is pumped into the circulation from the heart. In the decompression phase, the intrathoracic pressure decreases, and the return of blood to the heart is facilitated. In most societies, the improvements in interventions after cardiac arrest have not produced favorable results or have led to limited improvements [7,8]. In many studies investigating CPR failure, it was determined that the most im- portant reasons were the lack of experience and skill, in addition to

http://dx.doi.org/10.1016/j.ajem.2015.12.066

0735-6757/(C) 2015

Figure. The compression and decompression process performed by CardioPump.

inadequate chest compressions. It has been observed that cerebral and coronary perfusion cannot be facilitated at times, even with chest com- pressions performed in the best way possible [6]. In the American Heart Association (AHA) 2015 guidelines, it has been stated that the most im- portant components to facilitate the best circulation are fast, nonintermittent high-quality chest compressions that are begun as soon as possible. A variety of alternatives and adjuncts to conventional CPR have been developed, with the aim of enhancing perfusion during resuscitation from cardiac arrest. One of these alternative methods is ac- tive compression-decompression CPR (ACD-CPR) [9].

We planned our study due to the fact that the current evidence about ACD-CPR is insufficient. We aimed to contribute to the literature regarding ACD-CPR. The differences between conventional CPR and ACD-CPR using CardioPump were evaluated with respect to ROSC; res- toration of neurologic functions; 1-, 7-, and 30-day survival rates; and hospital discharge rates. The difference between the 2 methods with re- spect to rib fractures, pneumothorax/hemothorax, and internal organ damage was also investigated.

Materials and methods

Study population and study protocol

Our study was a prospective, randomized medical device study with a case-control group. The study was conducted at the Emergency Med- icine Clinic of the Konya Training and Research hospital. Our hospital in which the study was performed is the largest hospital in the region and also has the highest patient capacity. Our emergency department (ED) provides services to approximately 350 000 patients a year. Parallel to this, along with the very high density of patients at our ED, the daily number of emergency patients varies between 700 and 1000. Approxi- mately 1000 cardiac arrest patients are treated. Cardiac arrest cases brought to our emergency medicine clinic by the 112 emergency ambu- lances from outside the hospital and patients developing cardiac arrest in our hospital clinics between April 2015 and September 2015 were in- cluded in our study.

• Study inclusion criteria

  • Patients older than 18 years;
  • Patients developing cardiac arrest while being monitored in the ob- servational unit or emergency critical care unit of our emergency medicine clinic in the hospital; and
  • Out-of-hospital cardiac arrest patients who were brought in by the 112 emergency ambulances.

• Study exclusion criteria
  • Patients younger than 18 years;
  • Pregnant patients
  • Cardiac arrest cases secondary to reasons such as trauma, intoxica- tion, drowning, hypothermia, Electrolyte disorders, acute kidney failure, or cancer that requires specific interventions;
  • Cardiac arrest cases secondary to airway obstruction and respiratory failure;
  • Patients developing cardiac arrest out-of-hospital, who were brought in by the 112 emergency ambulances and who had not re- ceived CPR in accordance with the 2010 AHA guidelines, who did not have an advanced airway (endotracheal intubation tube, laryn- geal mask airway, combi tube, etc) or when it took longer than 30 minutes from the moment of the arrest to arrival at the ED; and
  • Patients who waited at the event site for more than 5 minutes with- out basic life support (BLS) CPR.

  Study devices

  The mechanic ACD-CPR device used in our study, CardioPump (also called ResQPump) is currently used in various clinical practices in com- pliance with CPR principles. The CardioPump permits the rescuer to ac- tively re-expand the chest during the decompression phase of CPR. Active compression-decompression CPR enhances the intrathoracic vacuum (negative pressure) during chest wall recoil, resulting in more blood returning to the heart (preload). Enhanced preload leads to in- creased cardiac output on the subsequent chest compression. The de- sign of the device allows the rescuer to use the same position and compression technique as standard CPR. The suction cup sticks to the chest and transfers a lifting force to the thorax. Active chest decompres- sion is obtained simply when the operator swings their body weight up- wards after each compression while holding on to the CardioPump’s handle. Chest compression is accomplished in the same manner as stan- dard Manual CPR by pushing down on the CardioPump [10,11]. The ACD-CPR device (CardioPump) is manufactured by Advanced Circulato- ry Systems, Inc (Roseville, MN) (Figure). The costs of the CardioPump device were covered by our hospital, and no other institutions or funds supported the study.

  Randomization and intervention

  The cases included in the study were separated into 2 groups: inhospital and out-of-hospital cardiac arrest cases. Out-of-hospital car- diac arrest patients received BLS or Advanced life support by the health care personnel who arrived at the scene with the ambulance in accordance with the 2010 AHA guidelines, and this intervention contin- ued nonintermittently until the patient reached our emergency unit. Pa- tients who reached the emergency unit continued to receive CPR using CardioPump. Inhospital patients received ALS-CPR using CardioPump directly according to the 2010 AHA guidelines. Out-of-hospital com- pressions were delivered at a compression-ventilation ratio of 30:2 ini- tially, after establishing an advanced airway, and compressions were set at 100 per minute as much as possible. For randomization, standard CPR was performed on odd days of each month, and CPR using CardioPump was performed on even days of each month. Finally, both methods were compared with respect to the success of returning spontaneous circula- tion; the 1-, 7-, and 30-day mortality rates; and the rates of discharge from hospital with restoration of neurologic functions (defined as a

  Table 1

  The study protocol

  

  Modified Rankin scale <= 3 as follows: 0 = asymptomatic, 1 = no signif- icant disability, 2 = slight disability, 3 = moderate disability, 4 = mod- erately severe disability, 5 = severe disability, 6 = dead) [12].

  Training

  The Ministry of Health of the Republic of Turkey provides annual BLS, ALS, and Advanced cardiac life support training and tests the health professionals who arrive at the scene by ambulance and the health care personnel. Furthermore, our hospital is one of the most important train- ing and research hospitals in the area that trains emergency medicine specialists in its emergency medicine clinic. In addition, they have been given the required education and information about the medical ACD-CPR device, CardioPump.

  Statistical analysis

  Statistical analysis was performed using the SPSS version 15.0 for Windows. Visual (histogram and probability graphs) and analytical (Kolmogorov-Smirnov and Shapiro-Wilk tests) methods were used to de- termine if the data were normally distributed. The descriptive variables

  were expressed as mean +- SD for normally distributed data and as median and interquartile range (IQR) for variables that were not normally distrib- uted. For comparison of the differences between the groups, the Mann- Whitney U test and the independent t test were used for the quantitative variables, and the ?² test was used for the categorical variables. P b .05 was accepted as statistically significant with a 95% confidence interval.

  The study protocol was approved by the local ethics committee and

  Republic of Turkey Ministry of Health Medical Devices and Drug Admin- istration and conducted in accordance with the Declaration of Helsinki and Good Clinical Practices.

  Results

  A total of 327 patients underwent CPR throughout the study. Among these, 88 patients were excluded from the study because the arrest was noncardiac; 22 were excluded because they had waited at the scene for more than 5 minutes without BLS-CPR; and 36 patients were excluded, either because they had not received CPR in accordance with the 2010 AHA guidelines or because they had no advanced airway or it had taken longer than 30 minutes for them to be brought to the hospital. In total, 181 patients were included in the study (Table 1). The mean

  Table 2

  Comparison of the conventional CPR method and the CardioPump CPR methods

  CPR method

  P

  lactate levels of the groups (P = .009). The median value of the Blood lactate levels of the group that received CPR using CardioPump was

  6.6 mmol (IQR, 4.4 mmol), and the median lactate level of the group that received conventional CPR was 4.1 (IQR, 4.1). Although the ROSC

  Conventional CPR (n = 86)

  CardioPump CPR (n = 95)

  rate was 61.7% in the patient group that received conventional CPR, it was 60.8% in the patient group that received CPR with CardioPump.

  Age (y) 70.2 +- 14.2 66.7 +- 13.7 .097

  Sex M, 48; F, 38 M, 51; F, 44 .774

  There was no statistical difference between the groups (P = .926). No statistically significant difference was observed between the 1-, 7-,

  First arrest rhythm Asystole, 56; VF/VT, 17; PEA, 13

  Asystole, 60;

  VF/VT, 23; PEA, 12

  .729

  and 30-day survival rates of the groups (P = .113, P = .347, and P =

  .293, respectively). When both groups were reviewed with respect to

  Arrest location IH, 47; OOH, 39 IH, 51; OOH, 44 .896

  Adrenalin dose (mg) 10 (IQR, 10) 12 (IQR, 10) .213

  CPR duration (min) 30 (IQR, 30) 40 (IQR, 30) .137

  Blood glucose (mg/dL) 182 (IQR, 107) 200 (IQR, 120) .104

  Lactate (mmol) 5.8 (IQR, 6.7) 7.3 (IQR, 6.3) .057

  pH 7.09 +- 0.18 7.06 +- 0.15 .163

  ROSC patient number 47 (54.6%) 58 (61.1%) .384

  Survival, day 1 38 patients (44.2%) 42 patients (44.2%) .997

  Survival, day 7 19 patients (22.1%) 25 patients (26.3%) .483

  Survival, day 30 11 patients (12.8%) 11 patients (11.6%) .803

  Discharge rate 9 patients (10.4%) 10 patients (10.6%) .601

  the discharge rates from hospital, among the patients discharged, 7 pa- tients (13.9%) were from the patient group that received conventional CPR, and 5 patients (9.8%) were from the patient group that received CPR with CardioPump. No statistically significant difference was ob- served between the groups (P = .510). Although complications devel- oped in 29 patients (61.7%) in the group that received conventional CPR, complications developed in 19 patients (37.3%) in the group that received CPR using CardioPump. The complication rate was statistically

  higher in the group that received conventional CPR (P = .016) (Table 4).

  No. of patients with complications

  64 (74.4%) 36 (37.8%) .001

  When we reviewed the out-of-hospital cardiac arrest patients, it was seen that the duration of arrival at the emergency unit was 15 minutes

  Abbreviations: IH, inhospital; OOH, out of hospital. ?² Test, Mann-Whitney U test, and in- dependent t test.

  age of the patients was 64.7 +- 13.8 years; 99 (54.7%) were male, and 82 (45.3%) were female. With respect to the location of the cardiac arrest, it occurred out of hospital in 83 (45.9%) and inhospital while being evalu- ated and treated in the emergency clinic in 98 (54.1%). The first arrest rhythm was asystole in 116 (64.1%), ventricular fibrillation/pulseless ventricular tachycardia (VF/VT) in 40 (22.1%), and Pulseless electrical activity in 25 (13.8%) of our patients. The number of patients who received conventional CPR was determined as 86 (47.5%), and the number of patients who received CPR using the CardioPump was determined as 95 (52.5%).

  Although the ROSC rate was 54.6% in the conventional CPR group, it was 61.1% in the group receiving CPR with CardioPump. There was no sta- tistical difference between the groups (P = .384). No statistically signifi- cant difference was determined between the 1-, 7-, and 30-day survival rates of the groups (P = .997, P = .483, and P = .803, respectively). When the groups were reviewed with respect to the hospital discharge rates, 9 patients (10.4%) in the conventional CPR group and 10 (10.6%) in the CardioPump CPR group were discharged. No statistically significant difference was observed between the groups (P = .601) (Table 2). Al- though complications developed in 64 patients (74.4%) in the conven- tional CPR group, 36 patients (37.8%) in the CPR using CardioPump group had complications. The complication rate was statistically higher in the group receiving conventional CPR (P b .001) (Table 3).

  Among the Inhospital CArdiac arrest cases, the median duration of

  CPR was 30 (IQR, 20) in the conventional CPR group and 35 (IQR, 35) in the CardioPump CPR group. The CPR duration was statistically longer

  (IQR, 10 minutes) in the patient group that received conventional CPR and 15 minutes (IQR, 10 minutes) in the patient group that received CPR using CardioPump (P = .367). Although the rate of ROSC was 46.2% in the group that received conventional CPR, it was 61.4% in the group that received CPR with CardioPump. There was no statistical dif- ference between the groups (P = .131). No statistical difference was ob- served between the 1-, 7-, and 30-day survival rates in either method (P = .085, P = .05, and P = .487, respectively). When the groups were reviewed with respect to the discharge rates from hospital, among the patients discharged, 2 (5.1%) were from the patient group that received conventional CPR, and 5 (11.4%) were from the patient group that received CPR using CardioPump. No statistically significant difference was observed between the groups (P = .244). Complications developed in 39 patients (89.7%) in the patient group that received con- ventional CPR and 17 patients (38.6%) in the patient group that received CPR using CardioPump. The complication rate is statistically higher in the group that received conventional CPR (P b .001) (Table 5).

  Discussion

  Active compression-decompression CPR is performed using a hand- held device with a suction cup applied over the midsternum of the

  Table 4

  Comparison of the conventional CPR method and the CardioPump CPR method in inhospital cardiac arrest patients

  CPR method

  P

  in the CardioPump CPR group (P = .038). There was no statistical differ-

  Conventional

  CPR (n = 47)

  CardioPump

  CPR (n = 51)

  ence between the blood gases, pH, and Blood sugar levels of the groups obtained in the emergency clinic during CPR (P = .286 and P = .227, re-

  Age (y) 70.3 +- 13.7 69.6 +- 13.2 .182

  Sex M, 21; F, 26 M, 26; F, 25 .553

  spectively). However, there was a statistical difference between the				First arrest rhythm	Asystole, 34; VF/VT, 7; PEA, 6	Asystole, 34; VF/VT, 11; PEA, 6	.695
  				Adrenalin dose (mg)	10 (IQR, 7)	10 (IQR, 12)	.055
  Table 3				CPR duration (min)	30 (IQR, 20)	35 (IQR, 35)	.038
  Comparison of the conventional CPR method and the CardioPump CPR methods with re-				Blood glucose (mg/dL)	180 (IQR, 102)	186 (IQR, 104)	.227
  spect to complications				Lactate (mmol)	4.1 (IQR, 4.1)	6.6 (IQR, 4.4)	.009
  				pH	7.12 +- 0.18	7.09 +- 0.16	.286
  Complications CPR method				ROSC patient number	29 (61.7%)	31 (60.8%)	.926
  	Conventional CPR	CardioPump CPR		Survival, day 1 Survival, day 7	25 patients (46.8%) 13 patients (27.7%)	19 patients (37.3%) 10 patients (19.6%)	.113 .347
  Rib fracture	52 (60.5%)	29 (30.5%)		Survival, day 30	8 patients (17%)	5 patients (9.8%)	.293
  Rib + sternum fracture	4 (4.7%)	1 (1.1%)		Discharge rate	7 patients (13.9%)	5 patients (9.8%)	.510
  Hemopneumothorax	8 (9.3%)	6 (6.3%)		No. of patients with	29 (61.7%)	19 (37.3%)	.016
  P	b.001			complications

  Mann-Whitney U test.

  ?² Test, Mann-Whitney U test, and independent t test.

  Table 5

  Comparison of the conventional CPR method and the CardioPump CPR method in out-of- hospital cardiac arrest patients

  	CPR method
  			P
  	Conventional	CardioPump
  	CPR (n = 39)	CPR (n = 44)
  Age (y)	66.3 +- 14.1	63.1 +- 13.8	.291
  Sex	M, 27; F, 12	M, 24; F, 20	.211
  Arrival to the ES (min)	15 (IQR, 10)	15 (IQR, 10)	.367
  First arrest rhythm Adrenalin dose (mg)	Asystole, 22; VF/VT, 10; PEA, 7 15 (IQR, 5)	Asystole, 25; VF/VT, 12; PEA, 7 13 (IQR, 10)	.880 .429
  CPR duration (min)	45 (IQR, 15)	40 (IQR, 30)	.562
  Blood glucose (mg/dL)	187 (IQR, 119)	222 (IQR, 138)	.273
  Lactate (mmol)	8.6 (IQR, 6)	9.3 (IQR, 7.2)	.557
  pH	7.06 +- 0.18	7.02 +- 0.16	.406
  ROSC patients number	18 (46.2%)	27 (61.4%)	.131
  Survival, day 1	13 patients (33.3%)	23 patients (52.3%)	.082
  Survival, day 7	6 patients (15.4%)	15 patients (34.1%)	.05
  Survival, day 30	3 patients (7.7%)	6 patients (13.6%)	.487
  Discharge rate	2 patients (5.1%)	5 patients (11.4%)	.244
  No. of patients with complications	35 (89.7%)	17 (38.6%)	.001

  ?² Test, Mann-Whitney U test, and independent t test.

  chest. After chest compression, the device is used to actively lift up the anterior chest during decompressions. The application of external neg- ative suction during decompression enhances the negative intrathoracic pressure (vacuum) generated by chest recoil, thereby increasing the ve- nous return (preload) to the heart and cardiac output during the next chest compression [9]. It has been shown in numerous previous human and animal studies that increasing negative intrathoracic pres- sure during the decompression phase of CPR performed in ACD-CPR in- creases the Coronary and cerebral perfusion [13-15]. It has also been seen from clinical trials that this approach increases the 24-hour surviv- al rates [10,11]. In their study on ACD-CPR, Aufderheide et al [12] deter- mined that, in cardiac arrest potentially of cardiac etiology, the rates of discharge from hospital and survival were higher compared to conven- tional CPR. In the study that they conducted, Wik et al [16] demonstrat- ed that ACD-CPR performed using CardioPump significantly increased short- and long-term survival rates. However, contradictory results have been obtained in various studies on ACD-CPR using CardioPump. Furthermore, the fact that it is rescuer dependent and the need to change rescuers frequently stand out as its negative aspects [17].

  Some animal and human studies have reported that Mechanical chest compressions are superior to manual chest compressions in cardi- ac arrest cases. Animal trials have shown that mechanical chest com- pressions better restore the central, cerebral, and Coronary blood flows [18-20]. Survival rates have also been observed to be better [21,22]. Various observational animal studies have shown that CPR application with Mechanical chest compressions improves the results [23-25], and the latest cohort study has shown that mechanical chest compres- sions also improve survival after being discharged from hospital. In an- other systematic review that contained nonrandomized studies, no improvement in the neurologic condition or survival was observed [26]. In the meta-analysis conducted by Westfall et al [27] comprising 12 randomized observational studies consisting of 6538 patients in total, it was demonstrated that CPR performed using mechanical medical de- vices was superior to conventional CPR with respect to ROSC. In addi- tion, when we reviewed the mechanical devices among themselves, it was determined that devices that wrap the rib cage are more successful than devices that function with a piston mechanism. However, it is an important drawback that none of the CPR performers in these studies were blinded. Furthermore, the success in returning spontaneous circu-

  lation has not been achieved within the durations of survival.

  The AHA 2015 guidelines state that there is only 1 randomized con- trolled low-quality study on ACD-CPR. It is not recommended to base

  the use of ACD-CPR on the results of this study. However, it has been sug- gested that it can be used in combination with conventional CPR in the presence of appropriate equipment and trained personnel [9]. In this study that we conducted, we did not detect any differences in ROSC; hos- pital discharge; and the 1-, 7-, and 30-day survival rates of the conven- tional CPR and CardioPump ACD-CPR groups, either. We obtained the same results in the inhospital arrest patients and the out-of-hospital ar- rest patients. Although the median CPR duration was longer in the group receiving CPR using CardioPump group, the ROSC; hospital dis- charge; and the 1-, 7-, and 30-day survival rates were the same as that in the conventional CPR group. However, the median lactate value was higher in the patient group that received CPR using CardioPump. The high lactate levels may have decreased the success rates.

  In the study conducted by Lu et al [28], it was stated that rib fractures occur less frequently in CPR performed using mechanical tools than in conventional CPR. However, it was seen that the rates of hemopneumothorax and internal organ damage were similar. The study conducted by Aufderheide et al [12] comparing ACD-CPR and convention- al CPR has shown that the rates of rib fracture, hemopneumothorax, and internal organ damage were similar. We did detect differences between the complication rates of both methods in our study. We observed that the rate of rib fractures was significantly higher in the patients intervened using conventional CPR. However, we identified similar rates of hemopneumothorax and internal organ damage.

  Limitations

  Our study had various limitations. First, in the out-of-hospital cardi- ac arrest cases, the 112 ambulance teams used the conventional CPR method during the intervention. This is because the ambulances could not be provided with CardioPump devices due to financial insufficiency. Second, the BLS-CPR support provided by bystanders during the first 5 minutes of the arrest does not have a certain standard. Furthermore, no definitive information could be obtained about the cases being witnessed or unwitnessed. Third, the single-center nature of our study and the low number of cases, as it was completed in 7 months, can also be listed as a limitation.

  Conclusions

  As a result of our study, we did not obtain any evidence that supports replacing conventional CPR with ACD-CPR performed using CardioPump. If the complication rates only are taken into account, then the complication rates, particularly the rib fracture rates, are lower in ACD-CPR using the CardioPump than the conventional CPR. It can be opted to decrease complications.

  Article summary

  Why is this topic important?

  Inhospital and out-of-hospital cardiac arrests are situations that have quite high mortality rates. The survival rates vary between 5% and 50%. Various degrees of brain damage develop in more than half of the survivors.

  What does this study attempt to show?

  We planned our study due to the fact that the current evidence about ACD-CPR is insufficient. We aimed to contribute to the literature regarding ACD-CPR. The differences between conventional CPR and ACD-CPR using CardioPump were evaluated with respect to ROSC; res- toration of neurologic functions; 1-, 7-, and 30-day survival rates; and hospital discharge rates. The difference between the 2 methods with re- spect to rib fractures, pneumothorax/hemothorax, and internal organ damage were also investigated.

  What are the key findings?

  A total of 181 patients were included in our study. The number of pa- tients who received conventional CPR was determined as 86 (47.5%), and the number of patients who received CPR using the CardioPump was determined as 95 (52.5%). We did not identify any difference be- tween conventional CPR and CardioPump ACD-CPR with respect to ROSC; discharge rates; and the 1-, 7-, and 30-day survival rates (P =

  .384, P = .601, P = .997, P = .483, and P = .803, respectively). The com- plication rate was higher in the patient group that received convention- al CPR (P b .001).

  How is patient care impacted?

  As a result of our study, we did not obtain any evidence that supports replacing conventional CPR with ACD-CPR performed using CardioPump. If the complication rates only are taken into account, then the complication rates, particularly the rib fracture rates, are lower in ACD-CPR using the CardioPump than the conventional CPR. It can be opted to decrease complications.

  References

  1. Taniguchi D, Baernstein A, Nichol G. Cardiac arrest: a public health perspective. Emerg Med Clin North Am 2012;30:1-12.
  2. Merchant RM, Yang L, Becker LB, et al, American Heart Association Get With The Guidelines-Resuscitation Investigators. Incidence of treated cardiac arrest in hospi- talized patients in the United States. Crit Care Med 2011;39:2401-6.
  3. Berg RA, Hemphill R, Abella BS, et al. Part 5: adult basic life support: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency car- diovascular care. Circulation 2010;122(Suppl. 3):S685-705.
  4. Herlitz J, Andersson E, Bang A, et al. Experiences from treatment of out-of-hospital cardiac arrest during 17 years in Goteborg. Eur Heart J 2000;21:1251-8.
  5. Young G. neurologic prognosis after cardiac arrest. N Engl J Med 2009;361:605-11.
  6. Brooks SC, Bigham BL, LJ M. Mechanical versus manual chest compressions for car- diac arrest. Cochrane Database Syst Rev 2011(1).
  7. Sasson C, Rogers MA, Dahl J, et al. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 2010; 3:63-81.
  8. Bradley SM, Huszti E, Warren SA, et al. Duration of hospital participation in Get With The Guidelines-Resuscitation and survival of inhospital cardiac arrest. Resuscitation 2012;83:1349-57.
  9. Brooks SC, Anderson ML, Bruder E, et al. 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Part 6: Alternative techniques and ancillary devices for cardiopulmonary resuscitation. Circulation 2015;132(Suppl. 2):S436-43.
  10. Wolcke BB, Mauer DK, Schoefmann MF, et al. Comparison of standard cardiopulmo- nary resuscitation versus the combination of active compression-decompression cardiopulmonary resuscitation and an inspiratory impedance threshold device for out-of-hospital cardiac arrest. Circulation 2003;108(18):2201-5.
  11. Plaisance P, Lurie KG, Vicaut E, et al. Evaluation of an impedance threshold device in patients receiving active compression-decompression cardiopulmonary resuscita- tion for out of hospital cardiac arrest. Resuscitation 2004;61(3):265-71.
  12. Aufderheide TP, Frascone RJ, Wayne MA, Mahoney, et al. Comparative effectiveness of standard CPR versus active compression decompression CPR with augmentation of negative intrathoracic pressure for treatment of out-of-hospital cardiac arrest: re- sults from a randomized prospective study. Lancet 2011;377(9762):301-11.
  13. Voelckel WG, Lurie KG, Sweeney M, et al. Effects of active compression- decompression cardiopulmonary resuscitation with the inspiratory threshold valve in a young porcine model of cardiac arrest. Pediatr Res 2002;51(4):523-7.
  14. Langhelle A, Stromme T, Sunde K, et al. Inspiratory impedance threshold valve dur- ing CPR. Resuscitation 2002;52(1):39-48.
  15. Aufderheide TP, Alexander C, Lick C, et al. From laboratory science to six emergency medical services systems: new understanding of the physiology of cardiopulmonary resuscitation increases survival rates after cardiac arrest. Crit Care Med 2008;36(11): S397-404.
  16. Wik L, Kramer-Johansen J, Myklebust H, et al. Quality of cardiopulmonary resuscita- tion during out-of-hospital cardiac arrest. JAMA 2005;293:299-304.
  17. Jane G, Wigginton S, Marshal Isaacs, Joseph J, Kay, et al. Mechanical devices for car- diopulmonary resuscitation. Curr Opin Crit Care. JAMA 2016;13:273-9.
  18. Halperin HR, Paradis N, Ornato JP, et al. Cardiopulmonary resuscitation with a novel chest compression device during a porcine model of cardiac arrest. J Am Coll Cardiol 2004;44(11):2214-20.
  19. Rubertsson S, Karlsten R. Increased cortical cerebral blood flow with LUCAS; a new device for mechanical chest compressions compared to standard external compres- sions during experimental cardiopulmonary resuscitation. Resuscitation 2005;65: 357-63.
  20. Timmerman S, Cardoso L, Ramires J. Improved hemodynamics with a novel chest compression device during treatment of in-hospital cardiac arrest. Prehosp Emerg Care 2003;7:162.
  21. Ikeno F, Kaneda H, Hongo Y, et al. Augmentation of tissue perfusion by a novel com- pression device increases Neurologically intact survival in a porcine model of prolonged cardiac arrest. Resuscitation 2006;68(1):109-18 : 0300-9572.
  22. Steen S, Liao Q, Pierre L, et al. Evaluation of LUCAS, a new device for automatic me- chanical compression and active decompression resuscitation. Resuscitation 2002; 55(3):285-99.
  23. Casner M, Andersen D, Isaacs SM. The impact of a new CPR device on rate of spon- taneous circulation in out-ofhospital cardiac arrest. Prehosp Emerg Care 2005; 9(1):61-7.
  24. Steen S, Sjoberg T, Olsson P, et al. Treatment of out-of-hospital cardiac arrest with LUCAS, a new device for automatic mechanical compression and active decompres- sion resuscitation. Resuscitation 2005;67(1):25-30.
  25. Swanson M, Poniatowski M, O’Keefe M, et al. A CPR assist device increased emergen- cy department admission and end tidal carbon dioxide partial pressures during treatment of out of hospital cardiac arrest. Circulation 2006;114(18):554.
  26. Ong ME, Ornato JP, Edwards DP, et al. Use of an automated, load-distributing band chest compression device for out-of-hospital cardiac arrest resuscitation. JAMA 2006;295(22):2629-37.
  27. Westfall M, Krantz S, Mullin C, et al. Mechanical versus manual chest compressions in out-of-hospital cardiac arrest: a meta-analysis. Crit Care Med 2013;41:1782-9.
  28. Lu XG, Kang X, Gong DB. The clinical efficacy of thumper modal 1007 cardiopulmo- nary resuscitation: a prospective randomized control trial. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue 2010;22(8):496-7.