Active compression-decompression CPR: a progress report

Within the last several years a new method of CPR, termed active compression-decompression (ACD) CPR was developed. Based upon the theory that active rather than passive chest wall decompression would augment venous return and ventilation by causing an increase in negative intrathoracic pressure during the decompression phase of CPR, a hand-held device was designed and is now being used clinically. Studies in dogs and pigs in ventricular fibrillation have demonstrated a significant improvement in systolic blood pressure, coronary perfusion pressure and total brain and myocardial blood flow with ACD CPR compared with standard CPR. Animal and human studies suggest that the mechanism of ACD CPR is complex, with coronary perfusion occurring during both the compression and decompression phases. Clinical studies comparing ACD to standard CPR in patients in cardiac arrest demonstrate that immediate resuscitation rates are nearly doubled when ACD CPR is started within 10 min after cardiac arrest. The potential long term benefits of ACD CPR remain under investigation.