Active chest compression‐decompression for cardiopulmonary resuscitation

Carmelo Lafuente‐Lafuente; María Melero‐Bascones

doi:10.1002/14651858.CD002751.pub2

Compresión‐descompresión activa del tórax para la reanimación cardiopulmonar

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Referencias

Referencias de los estudios incluidos en esta revisión

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estudios excluidos
otras referencias

Goralski M, Villéger JL, Cami G, Linassier P, Guilles‐des‐Buttes P, Fabbri P, et al. Evaluation of active compression‐decompression cardiopulmonary resuscitation in out‐of‐hospital cardiac arrest [Évaluation de la compression décompression active dans la réanimation de l'arrêt cardiaque extrahospitalier]. Réan Urg 1998;7:543‐50. [EMBASE: 1999119791]

Villeger JL, Linassier P, Skrobala D, Goralski M. Active compression decompression resuscitation in out‐of‐hospital cardiac arrest: preliminary results. Abstract: European Society of Anaesthesiologists Annual Congress Abstracts. Queen Elizabeth II Conference Centre, London. 1‐5 June, 1996. British Journal of Anaesthesia 1996;76(Suppl 2):115‐6. [PUBMED: 8679383]

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Ellinger K, Luiz T, Denz C, van‐Ackern K. Randomized use of an active compression‐decompression technique within the scope of preclinical resuscitation [Randomisierte Anwendung der aktiven Kompressions‐Dekompressions‐Technik (ACD) im Rahmen der präklinischen Reanimation]. Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS 1994;29(8):492‐500. [MEDLINE: 95143358]

Luiz T, Ellinger K, Denz C. Active compression‐decompression cardiopulmonary resuscitation does not improve survival in patients with prehospital cardiac arrest in a physician‐manned emergency medical system. Journal of Cardiothoracic and Vascular Anesthesia 1996;10(2):178‐86. [MEDLINE: 97003055]

Lurie KG, Shultz JJ, Callaham ML, Schwab TM, Gisch T, Rector T, et al. Evaluation of active compression‐decompression CPR in victims of out‐of‐hospital cardiac arrest. JAMA 1994;271:1405‐11. [MEDLINE: 94231638]

Mauer D, Schneider T, Dick W, Elich D, Mauer M. Active compression‐decompression resuscitation. Improved survival rate in an emergency medicine system with emergency physician assistance? [Aktive Kompressions‐ Dekompressions‐Reanimation (ACD‐CPR). Verbesserte Überlebensraten in einem notarztgestützten Rettungssystem?]. Medizinische Klinik 1997;92(7):381‐8. [MEDLINE: 97405441]

Mauer D, Schneider T, Dick W, Withelm A, Elich D, Mauer M. Active compression‐decompression resuscitation: a prospective, randomized study in a two‐tiered EMS system with physicians in the field. Resuscitation 1996;33(2):125‐34. [MEDLINE: 97177615]

Mauer D, Schneider T, Elich D, Dick W. Carbon dioxide levels during pre‐hospital active compression‐decompression versus standard cardiopulmonary resuscitation. Resuscitation 1998;39(1‐2):67‐74. [MEDLINE: 9918450]

Nolan J, Smith G, Evans R, McCusker K, Lubas P, Parr M, et al. The United Kingdom pre‐hospital study of active compression‐decompression resuscitation. Resuscitation 1998;37(2):119‐25. [MEDLINE: 1998334162]

Plaisance P, Adnet F, Vicaut E, Hennequin B, Magne P, Prudhomme C, et al. Benefit of active compression‐decompression cardiopulmonary resuscitation as a prehospital advanced cardiac life support: a randomized multicenter study. Circulation 1997;95(4):955‐61. [MEDLINE: 97207464]

Plaisance P, Lurie KG, Vicaut E, Adnet F, Petit JL, Epain D, et al. A comparison of standard cardiopulmonary resuscitation and active compression‐decompression resuscitation for out‐of‐hospital cardiac arrest. New England Journal of Medicine 1999;341(8):569‐75. [MEDLINE: 1999362123]

Callaham ML, Schwab TM, Shultz JJ, Utech TA, Madsen CD, Gist T, et al. A randomized prospective trial of active compression‐decompression CPR in prehospital cardiac arrest (abstract). Annals of Emergency Medicine 1993;22:174.

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Schwab TM, Callaham ML, Madsen CD, Utecht TA. A randomized clinical trial of active compression‐decompression CPR vs standard CPR in out‐of‐hospital cardiac arrest in two cities. JAMA 1995;273(16):1261‐8. [MEDLINE: 95230849]

Callaham ML, Schwab TM, Shultz JJ, Utech TA, Madsen CD, Gist T, et al. A randomized prospective trial of active compression‐decompression CPR in prehospital cardiac arrest (abstract). Annals of Emergency Medicine 1993;22:174.

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Schwab TM, Callaham ML, Madsen CD, Utecht TA. A randomized clinical trial of active compression‐decompression CPR vs standard CPR in out‐of‐hospital cardiac arrest in two cities. JAMA1995; Vol. 273, issue 16:1261‐8.

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Skogvoll E, Wik L. Active compression‐decompression cardiopulmonary resuscitation: a population‐based, prospective randomised clinical trial in out‐of‐hospital cardiac arrest. Resuscitation 1999;42(3):163‐72. [MEDLINE: 20088494]

Stiell IG, Hebert PC, Wells GA, Laupacis A, Vandemheen K, Dreyer JF, et al. The Ontario trial of active compression‐decompression cardiopulmonary resuscitation for in‐hospital and prehospital cardiac arrest. JAMA 1996;275(18):1417‐23. [MEDLINE: 96210341]

Stiell IG, Hebert PC, Wells GA, Laupacis A, Vandemheen K, Dreyer JF, et al. The Ontario trial of active compression‐decompression cardiopulmonary resuscitation for in‐hospital and prehospital cardiac arrest. JAMA1996; Vol. 275, issue 18:1417‐23.

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Tucker KJ, Galli F, Savitt MA, Kahsai D, Bresnahan L, Redberg RF. Active compression‐decompression resuscitation: effect on resuscitation success after in‐hospital cardiac arrest. Journal of the American College of Cardiology 1994;24(1):201‐9. [MEDLINE: 94274985]

Referencias de los estudios excluidos de esta revisión

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estudios incluidos
otras referencias

Arai T, Adachi N, Tabo E, Yorozuya T, Nagaro T, Ochi G, et al. Evaluation of efficiency of ACD‐CPR and STD‐CPR: a multi‐institutional study [Japanese]. Masui ‐ Japanese Journal of Anesthesiology 2001;50(3):307‐15. [PUBMED: 14568898]

Cohen TJ, Goldner BG, Maccaro PC, Ardito AP, Trazzera S, Cohen MB, et al. A comparison of active compression‐decompression cardiopulmonary resuscitation with standard cardiopulmonary resuscitation for cardiac arrests occurring in the hospital. New England Journal of Medicine 1993;329(26):1918‐21. [MEDLINE: 94067237]

Gueugniaud PY, Mols P, Goldstein P, Pham E, Dubien PY, Deweerdt C, et al. A comparison of repeated high doses and repeated standard doses of epinephrine for cardiac arrest outside the hospital. European Epinephrine Study Group. New England Journal of Medicine 1998;339(22):1595‐601. [MEDLINE: 99032032]

Lefrançois D. Prehospital use of ACD‐CPR in a EMT‐D level EMS system (abstract). Resuscitation 1998;37(2):S31.

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Panzer W, Bretthauer M, Klingler H, Bahr J Rathgeber J, Kettler D. ACD versus standard CPR in a prehospital setting. Resuscitation 1996;33(2):117‐24. [MEDLINE: 97177614]

Plaisance P, Lurie KG, Payen D. Inspiratory impedance during active compression‐decompression cardiopulmonary resuscitation: a randomized evaluation in patients in cardiac arrest. Circulation 2000;101(9):989‐94. [PUBMED: 10704165]

Plaisance P, Lurie KG, Vicaut E, Martin D, Gueugniaud PY, Petit JL, et al. Evaluation of an impedance threshold device in patients receiving active compression‐decompression cardiopulmonary resuscitation for out of hospital cardiac arrest. Resuscitation 2004;61(3):265‐71. [PUBMED: 15172704 ]

Rivers E, Boczar ME, Smithline HA, Lurie KJ, Nowak RM. A comparison of mechanical, standard and active compression‐decompression CPR in out‐of‐hospital cardiac arrest patients (abstract). Circulation 1993;88:I‐193.

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Wolcke BB, Mauer DK, Schoefmann MF, Teichmann H, Provo TA, Lindner KH, et al. Comparison of standard cardiopulmonary 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. [PUBMED: 14568898]

Referencias adicionales

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estudios incluidos
estudios excluidos

2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 2: Adult Basic Life Support. Circulation 2005 Nov 29;112(22 Suppl):III5‐III16.

Baubin M, Sumann G, Rabl W, Eibl G, Wenzel V, Mair P. Increased frequency of thorax injuries with ACD‐CPR. Resuscitation 1999;41(1):33‐8. [MEDLINE: 99387346]

Becker LB, Ostrander MP, Barrett J, Kondos GT. Outcome of CPR in a large metropolitan area‐where are the survivors?. Annals of Emergency Medicine 1991;20(4):355‐61. [MEDLINE: 91166102]

Brooks SC, Bigham BL, Morrison LJ. Mechanical chest compressions versus manual chest compressions for cardiac arrest. Cochrane Database of Systematic Reviews 2008, Issue 3. [DOI: 10.1002/14651858.CD007260]

Cohen TJ, Tucker KJ, Lurie KG, Redberg RF, Dutton JP, Dwyer KA, et al. Active compression‐decompression. A new method of cardiopulmonary resuscitation. Cardiopulmonary Resuscitation Working Group. JAMA 1992;267(21):2916‐23. [MEDLINE: 92260705]

Cohen TJ, Goldner BG, Maccaro PC, Ardito AP, Trazzera S, Cohen MB, et al. A comparison of active compression‐decompression cardiopulmonary resuscitation with standard cardiopulmonary resuscitation for cardiac arrests occurring in the hospital. New England Journal of Medicine 1993;329(26):1918‐21. [MEDLINE: 94067237]

de Vos R, Koster RW, De Haan RJ, Oosting H, van der Wouw PA, Lampe‐Schoenmaeckers AJ. In‐hospital cardiopulmonary resuscitation: prearrest morbidity and outcome. Archives of Internal Medicine 1999;159(8):845‐50. [MEDLINE: 99235336]

Ebell MH. Prearrest predictors of survival following in‐hospital cardiopulmonary resuscitation: a meta‐analysis. Journal of Family Practice 1992;34(5):551‐8. [MEDLINE: 92251314]

Eisenberg MS, Bergner L, Hallstrom A. Cardiac resuscitation in the community. Importance of rapid provision and implications for program planning. JAMA 1979;241(18):1905‐7. [MEDLINE: 79154439]

Handley AJ, Koster R, Monsieurs K, Perkins GD, Davies S, Bossaert L, European Resuscitation Council. European Resuscitation Council guidelines for resuscitation 2005. Section 2. Adult basic life support and use of automated external defibrillators. Resuscitation 2005;67(Suppl 1):S7‐S23. [MEDLINE: 16321717]

Higgins JPT, Altman DG (editors). Assessing risk of bias in included studies. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 (updated February 2008). The Cochrane Collaboration. Available from www.cochrane‐handbook.org, 2008.

Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies. In: Higgins JPT, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 (updated September 2009). The Cochrane Collaboration, 2009. Available from www.cochrane‐handbook.org..

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Malzer R, Zeiner A, Binder M, Domanovits H, Knappitsch G, Sterz F, et al. Hemodynamic effects of active compression‐decompression after prolonged CPR. Resuscitation 1996;31(3):243‐53. [MEDLINE: 96377570]

Mauer DK, Nolan J, Plaisance P, Sitter H, Benoit H, Stiell IG, et al. Effect of active compression‐decompression resuscitation (ACD‐CPR) on survival: a combined analysis using individual patient data. Resuscitation 1999;41(3):249‐56. [MEDLINE: 99435567]

Mullie A, Van Hoeyweghen R, Quets A. Influence of time intervals on outcome of CPR. The Cerebral Resuscitation Study Group. Resuscitation 1989;17 Suppl:S23‐33. [MEDLINE: 89387923]

Nichol G, Detsky AS, Stiell IG, O'Rourke K, Wells G, Laupacis A. Effectiveness of emergency medical services for victims of out‐of‐hospital cardiac arrest: a metaanalysis. Annals of Emergency Medicine 1996;27(6):700‐10. [MEDLINE: 96240168]

Orliaguet GA, Carli PA, Rozenberg A, Janniere D, Sauval P, Delpech P. End‐tidal carbon dioxide during out‐of‐hospital cardiac arrest resuscitation: comparison of active compression‐decompression and standard CPR. Annals of Emergency Medicine 1995;25(1):48‐51. [MEDLINE: 95100647]

Pepe PE, Levine RL, Fromm RE, Curka PA, Clark PS, Zachariah BS. Cardiac arrest presenting with rhythms other than ventricular fibrillation: contribution of resuscitative efforts toward total survivorship. Critical Care Medicine 1993;21(12):1838‐43. [MEDLINE: 94074325]

Plaisance P, Lurie KG, Vicaut E, Adnet F, Petit JL, Epain D, et al. A comparison of standard cardiopulmonary resuscitation and active compression‐decompression resuscitation for out‐of‐hospital cardiac arrest. New England Journal of Medicine 1999;341(8):569‐75. [MEDLINE: 1999362123]

Rabl W, Baubin M, Broinger G, Scheithauer R. Serious complications from active compression‐decompression cardiopulmonary resuscitation. International Journal of Legal Medicine 1996;109(2):84‐9. [MEDLINE: 97068865]

Schwab TM, Callaham ML, Madsen CD, Utecht TA. A randomized clinical trial of active compression‐decompression CPR vs standard CPR in out‐of‐hospital cardiac arrest in two cities. JAMA 1995;273(16):1261‐8. [MEDLINE: 95230849]

Shultz JJ, Coffeen P, Sweeney M, Detloff B, Kehler C, Pineda E, et al. Evaluation of standard and active compression‐decompression CPR in an acute human model of ventricular fibrillation. Circulation 1994;89(2):684‐93. [MEDLINE: 94147601]

Shultz JJ, Mianulli MJ, Gisch TM, Coffeen PR, Haidet GC, Lurie KG. Comparison of exertion required to perform standard and active compression‐decompression cardiopulmonary resuscitation. Resuscitation 1995;29(1):23‐31. [MEDLINE: 95304190]

Skogvoll E, Wik L. Active compression‐decompression cardiopulmonary resuscitation (ACD‐CPR) compared with standard CPR in a manikin model‐‐decompression force, compression rate, depth and duration. Resuscitation 1997;34(1):11‐6. [MEDLINE: 97204246]

Skogvoll E, Wik L. Active compression‐decompression cardiopulmonary resuscitation: a population‐based, prospective randomised clinical trial in out‐of‐hospital cardiac arrest. Resuscitation 1999;42(3):163‐72. [MEDLINE: 20088494]

Stiell IG, Hebert PC, Wells GA, Laupacis A, Vandemheen K, Dreyer JF, et al. The Ontario trial of active compression‐decompression cardiopulmonary resuscitation for in‐hospital and prehospital cardiac arrest. JAMA 1996;275(18):1417‐23. [MEDLINE: 96210341]

Sunde K, Wik L, Steen PA. Quality of mechanical, manual standard and active compression‐decompression CPR on the arrest site and during transport in a manikin model. Resuscitation 1997;34(3):235‐42. [MEDLINE: 97321676]

Tucker KJ, Redberg RF, Schiller NB, Cohen TJ. Active compression‐decompression resuscitation: analysis of transmitral flow and left ventricular volume by transesophageal echocardiography in humans. Cardiopulmonary Resuscitation Working Group. Journal of the American College of Cardiology 1993;22(5):1485‐93. [MEDLINE: 94044260]

Tucker KJ, Galli F, Savitt MA, Kahsai D, Bresnahan L, Redberg RF. Active compression‐decompression resuscitation: effect on resuscitation success after in‐hospital cardiac arrest. Journal of the American College of Cardiology 1994;24(1):201‐9. [MEDLINE: 94274985]

Zoch TW, Desbiens NA, DeStefano F, Stueland DT, Layde PM. Short‐ and long‐term survival after cardiopulmonary resuscitation. Archives of Internal Medicine 2000;160(13):1969‐73. [MEDLINE: 20347643]

Characteristics of studies

Characteristics of included studies [ordered by study ID]

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estudios excluidos

Goralski 1998

Methods	Randomized controlled trial.
Participants	n = 150. Mean age: 61.5 y. Male: 72%. Exclusions: trauma victims. VF: 15%. Cardiac cause of heart arrest: 70%
Interventions	ACDR vs. STR. Physician in responder team. Mean response time: 16 mins. Mean adrenaline dose: 12.5 mg.
Outcomes	Immediate and at hospital discharge mortality.
Notes	Pre‐hospital. Orleans, Tours (France). 1995‐1996.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Luiz 1996

Methods	Randomized controlled trial.
Participants	n = 61. Mean age: 69 y. Male: 73%. Exclusions: pregnancy, trauma victims. VF: 27%. Cardiac antecedents: 52%. Pulmonary antecedents: 12.5%.
Interventions	ACDR vs. STR. Physician in responder team. Mean response time: 8 mins. Adrenaline dose: ?.
Outcomes	Immediate and at hospital discharge mortality. Neurological outcome. Complications.
Notes	Pre‐hospital. Mannheim (Germany). 1993.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B ‐ Unclear

Lurie 1994

Methods	Randomized controlled trial.
Participants	n = 130. Mean age: 67 y. Male: 72%. Exclusions: hypothermia, trauma victims. VF: 62%. Cardiac antecedents: 62%
Interventions	ACDR vs. STR. Only paramedics in responder team. Mean response time: 5.2 mins. Mean adrenaline dose: 2.7 mg.
Outcomes	Immediate and at hospital discharge mortality. Complications.
Notes	Pre‐hospital. St.Paul (USA). 1992‐1993.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	High risk	C ‐ Inadequate

Mauer 1996

Methods	Randomized controlled trial.
Participants	n = 220. Mean age: 68.7 y. Male: ?. Exclusions: pregnancy, hypothermia, drowning, overdose, trauma victims. VF: 45%. Cardiac antecedents: 61%. Pulmonary antecedents: 12.7%.
Interventions	ACDR vs. STR. Physician in responder team. Mean response time: nine mins. Mean adrenaline dose: 4.3 mg.
Outcomes	Immediate and at hospital discharge mortality. Complications.
Notes	Pre‐hospital. Mainz (Germany). 1992‐1995.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Nolan 1998

Methods	Randomized controlled trial.
Participants	n = 674. Mean age: 67 y. Male: 68%. Exclusions: trauma victims. VF: 60%.
Interventions	ACDR vs. STR. Only paramedics in responder team. Mean response time: 8.7 mins. Adrenaline dose: ?.
Outcomes	Immediate and at hospital discharge mortality. Neurological outcome. Complications.
Notes	Pre‐hospital. Cardiff, Portsmouth, Bristol (UK). 1994‐1995.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	High risk	C ‐ Inadequate

Plaisance 1999

Methods	Randomized controlled trial.
Participants	n = 750. Mean age: 58.5 y. Male: 68%. Exclusions: irreversible death, excessive delay. VF: 12%. Cardiac cause of heart arrest: 64%.
Interventions	ACDR vs. STR. Physician in responder team. Mean response time: 9.2 mins. Mean adrenaline dose: 14.3 mg.
Outcomes	Immediate mortality. Complications. Intention‐to‐treatanalysis was explicitly done.
Notes	Pre‐hospital. Paris (France). 1993‐1995.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	High risk	C ‐ Inadequate

Schwab‐Fresno 1995

Methods	Randomized controlled trial.
Participants	n = 253. Mean age: 65 y. Male: 61%. Exclusions: trauma victims, hypothermia. VF: 38%.
Interventions	ACDR vs. STR. Only paramedics in responder team. Mean response time: 5.3 mins. Adrenaline dose: ?.
Outcomes	Immediate and at hospital discharge mortality. Complications.
Notes	Pre‐hospital. Fresno (USA). 1992‐1993.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	High risk	C ‐ Inadequate

Schwab‐S.Francisco 1995

Methods	Randomized controlled trial.
Participants	n = 607. Mean age: 65 y. Male: 67%. Exclusions: trauma victims, hypothermia. VF: 18%.
Interventions	ACDR vs. STR. Mean response time: 5.5 mins. Adrenaline dose: ?.
Outcomes	Immediate and at hospital discharge mortality. Complications.
Notes	Pre‐hospital. San Francisco (USA). 1992‐1993.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	High risk	C ‐ Inadequate

Skogvoll 1999

Methods	Randomized controlled trial.
Participants	n = 306. Mean age: 71 y. Male: 73%. Exclusions: trauma victims, intoxication, airway obstruction. VF: 57%.
Interventions	ACDR vs. STR. Physician in responder team. Mean response time: 9 mins. Adrenaline dose: ?.
Outcomes	Immediate and at hospital discharge mortality. Neurological outcome. Intention‐to‐treatanalysis was explicitly done.
Notes	Pre‐hospital. Trondheim (Norway). 1994‐1998.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Stiell‐Inhospital 1996

Methods	Randomized controlled trial.
Participants	n = 773. Mean age: 68.5 y. Male: 57%. Exclusions: trauma, recent sternotomy, operating room. VF: 32%. Cardiac antecedents: 49%. Cardiac cause of heart arrest: 77%. Respiratory cause: 16%
Interventions	ACDR vs. STR. Physician in responder team. Mean response time: 1.4 mins. Adrenaline dose: ?.
Outcomes	Immediate and at hospital discharge mortality. Neurological outcome. Complications. Intention‐to‐treatanalysis was explicitly done.
Notes	In‐hospital. Otawa, London (Canada). 1993‐1995.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Stiell‐Prehospital 1996

Methods	Randomized controlled trial.
Participants	n = 1011. Mean age: 68 y. Male: 63%. Exclusions: trauma, excessive delay. VF: 32.5%. Cardiac antecedents: 49%. Cardiac cause of heart arrest: 86%. Respiratory cause: 8%.
Interventions	ACDR vs. STR. Only paramedics in responder team. Mean response time: 5.2 mins. Adrenaline dose: ?.
Outcomes	Immediate and at hospital discharge mortality. Neurological outcome. Complications. Intention‐to‐treatanalysis was explicitly done.
Notes	Pre‐hospital. Otawa, London (Canada). 1993‐1995.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A ‐ Adequate

Tucker 1994

Methods	Randomized controlled trial.
Participants	n = 53. Mean age: 71 y. Male: 43%. Exclusions: trauma victims, pregnancy. VF: 28%. Cardiac antecedents: 58%.
Interventions	ACDR vs. STR. Physician in responder team. Mean response time: 2 mins. Adrenaline dose: ?.
Outcomes	Immediate and at hospital discharge mortality. Neurological outcome. Intention‐to‐treatanalysis was explicitly done.
Notes	In‐hospital. San Francisco (USA). 1992‐1993.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Allocation concealment?	High risk	C ‐ Inadequate

n = number of patients included in the study.
VF = presenting ventricular fibrillation or ventricular tachycardia as initial electrical rhythm.
ACDR = active chest compression‐decompression resuscitation.
STR = standard resuscitation (manual chest compression).

Characteristics of excluded studies [ordered by study ID]

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estudios incluidos

Study	Reason for exclusion
Arai 2001	Not randomized
Cohen 1993	60% of included patients had a known preexisting terminal disease
Gueugniaud 1998	Patients were randomized to receive high or standard doses of adrenaline. Some patients included in this study received ACDR, but they were not randomized to receive ACDR or STR.
Lefrançois 1998	Not randomized
Panzer 1996	Retrospective, not randomized
Plaisance‐ITD 2004	ACDR CPR was applied to all patients groups. This trial studied the effect of a respiratory impedance threshold device compared to usual ventilation
Rivers 1993	Alternation of different methods of chest compression on the same patient
Wolcke 2003	Therapeutic interventions other than the method of chest compression were different: ACDR was combined with an inspiratory impedance threshold device (ITD). Control group received neither ACDR nor ITD.

Data and analyses

Open in table viewer

Comparison 1. Out‐of‐hospital cardiac arrests

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Immediate mortality Show forest plot	10	4162	Risk Ratio (M‐H, Random, 95% CI)	0.98 [0.94, 1.03]
Open in figure viewer Analysis 1.1 Comparison 1 Out‐of‐hospital cardiac arrests, Outcome 1 Immediate mortality.
2 Mortality at hospital discharge Show forest plot	9	3412	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.98, 1.01]
Open in figure viewer Analysis 1.2 Comparison 1 Out‐of‐hospital cardiac arrests, Outcome 2 Mortality at hospital discharge.
3 Neurological impairment in survivors Show forest plot	5	358	Risk Ratio (M‐H, Fixed, 95% CI)	1.74 [1.06, 2.83]
Open in figure viewer Analysis 1.3 Comparison 1 Out‐of‐hospital cardiac arrests, Outcome 3 Neurological impairment in survivors.
3.1 Moderate neurological impairment	4	107	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.34, 2.79]
3.2 Severe neurological impairment	4	107	Risk Ratio (M‐H, Fixed, 95% CI)	3.11 [0.98, 9.83]
3.3 Any neurological impairment (any severity)	5	144	Risk Ratio (M‐H, Fixed, 95% CI)	1.71 [0.90, 3.25]
4 Complications Show forest plot	7	3032	Risk Ratio (M‐H, Fixed, 95% CI)	1.09 [0.86, 1.38]
Open in figure viewer Analysis 1.4 Comparison 1 Out‐of‐hospital cardiac arrests, Outcome 4 Complications.

Open in table viewer

Comparison 2. In‐hospital cardiac arrests

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Immediate mortality Show forest plot	2	826	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.88, 1.08]
Open in figure viewer Analysis 2.1 Comparison 2 In‐hospital cardiac arrests, Outcome 1 Immediate mortality.
2 Mortality at hospital discharge Show forest plot	2	826	Risk Ratio (M‐H, Fixed, 95% CI)	1.00 [0.95, 1.05]
Open in figure viewer Analysis 2.2 Comparison 2 In‐hospital cardiac arrests, Outcome 2 Mortality at hospital discharge.
3 Neurological impairment in survivors Show forest plot	2	279	Risk Ratio (M‐H, Fixed, 95% CI)	1.19 [0.63, 2.25]
Open in figure viewer Analysis 2.3 Comparison 2 In‐hospital cardiac arrests, Outcome 3 Neurological impairment in survivors.
3.1 Moderate neurologic impairment	2	93	Risk Ratio (M‐H, Fixed, 95% CI)	0.5 [0.10, 2.58]
3.2 Severe neurologic impairment	2	93	Risk Ratio (M‐H, Fixed, 95% CI)	1.95 [0.59, 6.50]
3.3 Any neurological impairment (any severity)	2	93	Risk Ratio (M‐H, Fixed, 95% CI)	1.19 [0.50, 2.86]
4 Complications Show forest plot	1	773	Risk Ratio (M‐H, Fixed, 95% CI)	0.97 [0.49, 1.93]
Open in figure viewer Analysis 2.4 Comparison 2 In‐hospital cardiac arrests, Outcome 4 Complications.

Open in table viewer

Comparison 3. Subgroup analysis: Physician in first responding team or only paramedics

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Immediate mortality Show forest plot	10	4162	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.94, 1.01]
Open in figure viewer Analysis 3.1 Comparison 3 Subgroup analysis: Physician in first responding team or only paramedics, Outcome 1 Immediate mortality.
1.1 Physician in first responding team	5	1487	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.89, 1.04]
1.2 Only paramedics in first responding team	5	2675	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.95, 1.02]
2 Mortality at hospital discharge Show forest plot	9	3412	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.98, 1.01]
Open in figure viewer Analysis 3.2 Comparison 3 Subgroup analysis: Physician in first responding team or only paramedics, Outcome 2 Mortality at hospital discharge.
2.1 Physician in first responding team	4	737	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.94, 1.04]
2.2 Only paramedics in first responding team	5	2675	Risk Ratio (M‐H, Fixed, 95% CI)	1.00 [0.98, 1.01]
3 Neurological impairment in survivors (any severity) Show forest plot	5	144	Risk Ratio (M‐H, Fixed, 95% CI)	1.71 [0.90, 3.25]
Open in figure viewer Analysis 3.3 Comparison 3 Subgroup analysis: Physician in first responding team or only paramedics, Outcome 3 Neurological impairment in survivors (any severity).
3.1 Physician in first responding team	2	44	Risk Ratio (M‐H, Fixed, 95% CI)	1.07 [0.41, 2.80]
3.2 Only paramedics in first responding team	3	100	Risk Ratio (M‐H, Fixed, 95% CI)	2.19 [0.93, 5.13]

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Comparison 4. Sensitivity analysis: Best quality studies

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Immediate mortality Show forest plot	12	4988	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.95, 1.01]
Open in figure viewer Analysis 4.1 Comparison 4 Sensitivity analysis: Best quality studies, Outcome 1 Immediate mortality.
1.1 Allocation concealment adequate	5	2460	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.96, 1.06]
1.2 Allocation concealment unclear	1	61	Risk Ratio (M‐H, Fixed, 95% CI)	1.13 [0.77, 1.65]
1.3 Allocation concealment inadequate	6	2467	Risk Ratio (M‐H, Fixed, 95% CI)	0.94 [0.90, 0.99]
2 Mortality at hospital discharge Show forest plot	11	4238	Risk Ratio (M‐H, Fixed, 95% CI)	1.00 [0.98, 1.01]
Open in figure viewer Analysis 4.2 Comparison 4 Sensitivity analysis: Best quality studies, Outcome 2 Mortality at hospital discharge.
2.1 Allocation concealment adequate	5	2460	Risk Ratio (M‐H, Fixed, 95% CI)	1.00 [0.97, 1.02]
2.2 Allocation concealment unclear	1	61	Risk Ratio (M‐H, Fixed, 95% CI)	1.04 [0.87, 1.25]
2.3 Allocation concealment inadequate	5	1717	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.97, 1.02]
3 Neurological impairment in survivors (any severity) Show forest plot	7	237	Risk Ratio (M‐H, Fixed, 95% CI)	1.50 [0.89, 2.51]
Open in figure viewer Analysis 4.3 Comparison 4 Sensitivity analysis: Best quality studies, Outcome 3 Neurological impairment in survivors (any severity).
3.1 Allocation concealment adequate	3	163	Risk Ratio (M‐H, Fixed, 95% CI)	1.45 [0.75, 2.79]
3.2 Allocation concealment unclear	1	7	Risk Ratio (M‐H, Fixed, 95% CI)	0.89 [0.33, 2.37]
3.3 Allocation concealment inadequate	3	67	Risk Ratio (M‐H, Fixed, 95% CI)	2.09 [0.67, 6.54]

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Comparison 5. Sensitivity analysis: Largest (n > 500) studies

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Immediate mortality Show forest plot	5	3815	Risk Ratio (M‐H, Fixed, 95% CI)	0.97 [0.93, 1.00]
Open in figure viewer Analysis 5.1 Comparison 5 Sensitivity analysis: Largest (n > 500) studies, Outcome 1 Immediate mortality.
2 Mortality at hospital discharge Show forest plot	4	3065	Risk Ratio (M‐H, Fixed, 95% CI)	1.00 [0.98, 1.02]
Open in figure viewer Analysis 5.2 Comparison 5 Sensitivity analysis: Largest (n > 500) studies, Outcome 2 Mortality at hospital discharge.
3 Neurological impairment in survivors (any severity) Show forest plot	3	159	Risk Ratio (M‐H, Fixed, 95% CI)	1.60 [0.81, 3.16]
Open in figure viewer Analysis 5.3 Comparison 5 Sensitivity analysis: Largest (n > 500) studies, Outcome 3 Neurological impairment in survivors (any severity).

Analysis 1.1

Comparison 1 Out‐of‐hospital cardiac arrests, Outcome 1 Immediate mortality.

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Analysis 1.2

Comparison 1 Out‐of‐hospital cardiac arrests, Outcome 2 Mortality at hospital discharge.

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Analysis 1.3

Comparison 1 Out‐of‐hospital cardiac arrests, Outcome 3 Neurological impairment in survivors.

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Analysis 1.4

Comparison 1 Out‐of‐hospital cardiac arrests, Outcome 4 Complications.

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Analysis 2.1

Comparison 2 In‐hospital cardiac arrests, Outcome 1 Immediate mortality.

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Analysis 2.2

Comparison 2 In‐hospital cardiac arrests, Outcome 2 Mortality at hospital discharge.

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Analysis 2.3

Comparison 2 In‐hospital cardiac arrests, Outcome 3 Neurological impairment in survivors.

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Analysis 2.4

Comparison 2 In‐hospital cardiac arrests, Outcome 4 Complications.

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Analysis 3.1

Comparison 3 Subgroup analysis: Physician in first responding team or only paramedics, Outcome 1 Immediate mortality.

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Analysis 3.2

Comparison 3 Subgroup analysis: Physician in first responding team or only paramedics, Outcome 2 Mortality at hospital discharge.

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Analysis 3.3

Comparison 3 Subgroup analysis: Physician in first responding team or only paramedics, Outcome 3 Neurological impairment in survivors (any severity).

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Analysis 4.1

Comparison 4 Sensitivity analysis: Best quality studies, Outcome 1 Immediate mortality.

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Analysis 4.2

Comparison 4 Sensitivity analysis: Best quality studies, Outcome 2 Mortality at hospital discharge.

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Analysis 4.3

Comparison 4 Sensitivity analysis: Best quality studies, Outcome 3 Neurological impairment in survivors (any severity).

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Analysis 5.1

Comparison 5 Sensitivity analysis: Largest (n > 500) studies, Outcome 1 Immediate mortality.

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Analysis 5.2

Comparison 5 Sensitivity analysis: Largest (n > 500) studies, Outcome 2 Mortality at hospital discharge.

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Analysis 5.3

Comparison 5 Sensitivity analysis: Largest (n > 500) studies, Outcome 3 Neurological impairment in survivors (any severity).

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Comparison 1. Out‐of‐hospital cardiac arrests

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Immediate mortality Show forest plot	10	4162	Risk Ratio (M‐H, Random, 95% CI)	0.98 [0.94, 1.03]

2 Mortality at hospital discharge Show forest plot	9	3412	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.98, 1.01]

3 Neurological impairment in survivors Show forest plot	5	358	Risk Ratio (M‐H, Fixed, 95% CI)	1.74 [1.06, 2.83]

3.1 Moderate neurological impairment	4	107	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.34, 2.79]
3.2 Severe neurological impairment	4	107	Risk Ratio (M‐H, Fixed, 95% CI)	3.11 [0.98, 9.83]
3.3 Any neurological impairment (any severity)	5	144	Risk Ratio (M‐H, Fixed, 95% CI)	1.71 [0.90, 3.25]
4 Complications Show forest plot	7	3032	Risk Ratio (M‐H, Fixed, 95% CI)	1.09 [0.86, 1.38]

Comparison 1. Out‐of‐hospital cardiac arrests

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Comparison 2. In‐hospital cardiac arrests

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Immediate mortality Show forest plot	2	826	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.88, 1.08]

2 Mortality at hospital discharge Show forest plot	2	826	Risk Ratio (M‐H, Fixed, 95% CI)	1.00 [0.95, 1.05]

3 Neurological impairment in survivors Show forest plot	2	279	Risk Ratio (M‐H, Fixed, 95% CI)	1.19 [0.63, 2.25]

3.1 Moderate neurologic impairment	2	93	Risk Ratio (M‐H, Fixed, 95% CI)	0.5 [0.10, 2.58]
3.2 Severe neurologic impairment	2	93	Risk Ratio (M‐H, Fixed, 95% CI)	1.95 [0.59, 6.50]
3.3 Any neurological impairment (any severity)	2	93	Risk Ratio (M‐H, Fixed, 95% CI)	1.19 [0.50, 2.86]
4 Complications Show forest plot	1	773	Risk Ratio (M‐H, Fixed, 95% CI)	0.97 [0.49, 1.93]

Comparison 2. In‐hospital cardiac arrests

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Comparison 3. Subgroup analysis: Physician in first responding team or only paramedics

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Immediate mortality Show forest plot	10	4162	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.94, 1.01]

1.1 Physician in first responding team	5	1487	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.89, 1.04]
1.2 Only paramedics in first responding team	5	2675	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.95, 1.02]
2 Mortality at hospital discharge Show forest plot	9	3412	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.98, 1.01]

2.1 Physician in first responding team	4	737	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.94, 1.04]
2.2 Only paramedics in first responding team	5	2675	Risk Ratio (M‐H, Fixed, 95% CI)	1.00 [0.98, 1.01]
3 Neurological impairment in survivors (any severity) Show forest plot	5	144	Risk Ratio (M‐H, Fixed, 95% CI)	1.71 [0.90, 3.25]

3.1 Physician in first responding team	2	44	Risk Ratio (M‐H, Fixed, 95% CI)	1.07 [0.41, 2.80]
3.2 Only paramedics in first responding team	3	100	Risk Ratio (M‐H, Fixed, 95% CI)	2.19 [0.93, 5.13]

Comparison 3. Subgroup analysis: Physician in first responding team or only paramedics

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Comparison 4. Sensitivity analysis: Best quality studies

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Immediate mortality Show forest plot	12	4988	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.95, 1.01]

1.1 Allocation concealment adequate	5	2460	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.96, 1.06]
1.2 Allocation concealment unclear	1	61	Risk Ratio (M‐H, Fixed, 95% CI)	1.13 [0.77, 1.65]
1.3 Allocation concealment inadequate	6	2467	Risk Ratio (M‐H, Fixed, 95% CI)	0.94 [0.90, 0.99]
2 Mortality at hospital discharge Show forest plot	11	4238	Risk Ratio (M‐H, Fixed, 95% CI)	1.00 [0.98, 1.01]

2.1 Allocation concealment adequate	5	2460	Risk Ratio (M‐H, Fixed, 95% CI)	1.00 [0.97, 1.02]
2.2 Allocation concealment unclear	1	61	Risk Ratio (M‐H, Fixed, 95% CI)	1.04 [0.87, 1.25]
2.3 Allocation concealment inadequate	5	1717	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.97, 1.02]
3 Neurological impairment in survivors (any severity) Show forest plot	7	237	Risk Ratio (M‐H, Fixed, 95% CI)	1.50 [0.89, 2.51]

3.1 Allocation concealment adequate	3	163	Risk Ratio (M‐H, Fixed, 95% CI)	1.45 [0.75, 2.79]
3.2 Allocation concealment unclear	1	7	Risk Ratio (M‐H, Fixed, 95% CI)	0.89 [0.33, 2.37]
3.3 Allocation concealment inadequate	3	67	Risk Ratio (M‐H, Fixed, 95% CI)	2.09 [0.67, 6.54]

Comparison 4. Sensitivity analysis: Best quality studies

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Comparison 5. Sensitivity analysis: Largest (n > 500) studies

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Immediate mortality Show forest plot	5	3815	Risk Ratio (M‐H, Fixed, 95% CI)	0.97 [0.93, 1.00]

2 Mortality at hospital discharge Show forest plot	4	3065	Risk Ratio (M‐H, Fixed, 95% CI)	1.00 [0.98, 1.02]

3 Neurological impairment in survivors (any severity) Show forest plot	3	159	Risk Ratio (M‐H, Fixed, 95% CI)	1.60 [0.81, 3.16]

Comparison 5. Sensitivity analysis: Largest (n > 500) studies

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Referencias

Referencias de los estudios incluidos en esta revisión

Goralski 1998 {published data only}

Luiz 1996 {published data only}

Lurie 1994 {published data only}

Mauer 1996 {published data only}

Nolan 1998 {published data only}

Plaisance 1999 {published and unpublished data}

Schwab‐Fresno 1995 {published data only}

Schwab‐S.Francisco 1995 {published data only}

Skogvoll 1999 {published and unpublished data}

Stiell‐Inhospital 1996 {published data only}

Stiell‐Prehospital 1996 {published data only}

Tucker 1994 {published data only}

Referencias de los estudios excluidos de esta revisión

Arai 2001 {published data only}

Cohen 1993 {published data only}

Gueugniaud 1998 {published data only}

Lefrançois 1998 {published data only}

Panzer 1996 {published data only}

Plaisance‐ITD 2004 {published data only}

Rivers 1993 {published data only}

Wolcke 2003 {published data only}

Referencias adicionales

AHA 2005

Baubin 1999

Becker 1991

Brooks 2008

Cohen 1992

Cohen 1993

de Vos 1999

Ebell 1992

Eisenberg 1979

ERC 2005

Higgins 2008

Lefebvre 2009

Malzer 1996

Mauer 1999

Mullie 1989

Nichol 1996

Orliaguet 1995

Pepe 1993

Plaisance 1999

Rabl 1996

Schwab 1995

Shultz 1994

Shultz 1995

Skogvoll 1997

Skogvoll 1999

Stiell 1996

Sunde 1997

Tucker 1993

Tucker 1994

Zoch 2000

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Characteristics of excluded studies [ordered by study ID]

Data and analyses

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Instituciones a las que se accedió previamente

Usuarios institucionales

Instituciones a las que se accedió previamente

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