The first European pre-hospital active compression-decompression (ACD) cardiopulmonary resuscitation workshop: A report and a review of ACD-CPR

Active compression-decompression cardiopulmonary resuscitation (ACD-CPR) has been evaluated in animal cardiac arrest models and in human outcome studies. Blood flow to the brain and heart is significantly increased during ACD-CPR compared to standard CPR. Transoesophageal Doppler analysis indicates that ACD-CPR increases left ventricular blood volume, velocity of blood flow through the mitral valve (82-140%), and stroke volume (85%). Pressures, such as coronary perfusion-, systolic-, mean-, and diastolic aortic pressures, ETCO(2) and tidal volume generated by chest compression and decompression, increase during ACD-CPR compared to standard CPR. Prehospital outcome studies have shown both positive and no extra benefit of ACD-CPR on return of spontaneous circulation, hospital admission, and discharge rates. The ACD-CPR method should be evaluated in patients with witnessed arrest receiving bystander CPR who are found in ventricular fibrillation and do not respond to the three initial DC shocks. There is no evidence that ACD-CPR is worse than standard CPR. Appropriate ACD-CPR training using a standardized curriculum must preceed its implementation. Long-term neurologic outcome studies are needed.