• I G Stiell, P C Hébert, G A Wells, A Laupacis, K Vandemheen, J F Dreyer, M A Eisenhauer, J Gibson, L A Higginson, A S Kirby, J L Mahon, J P Maloney, and B N Weitzman.
• Division of Emergency Medicine, University of Ottawa, Ontario, Canada.
• JAMA. 1996 May 8;275(18):1417-23.

ObjectiveTo compare the impact of active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) and standard CPR on the outcomes of in-hospital and prehospital victims of cardiac arrest.DesignRandomized controlled trial with blinding of allocation using a sealed container.Settings(1) Emergency departments, wards, and intensive care units of 5 university hospitals and (2) all locations outside hospitals in 2 midsized cities.PatientsA total of 1784 adults who had cardiac arrest.InterventionPatients received either standard or ACD CPR throughout resuscitation.Main Outcome MeasuresSurvival for 1 hour and to hospital discharge and the modified Mini-Mental State Examination (MMSE).ResultsAll characteristics were similar in the standard and ACD CPR groups for the 773 in-hospital patients and the 1011 prehospital patients. For in-hospital patients, there were no significant differences between the standard (n = 368) and ACD (n = 405) CPR groups in survival for 1 hour (35.1% vs 34.6%; P = .89), in survival until hospital discharge (11.4% vs 10.4%; P = .64), or in the median MMSE score of survivors (37 in both groups). For patients who collapsed outside the hospital, there were also no significant differences between the standard (n = 510) and ACD (n = 501) CPR groups in survival for 1 hour (16.5% vs 18.2%; P = .48), in survival to hospital discharge (3.7% vs 4.6%; P = .49), or in the median MMSE score of survivors (35 in both groups). Exploration of clinically important subgroups failed to identify any patients who appeared to benefit from ACD CPR.ConclusionsACD CPR did not improve survival or neurologic outcomes in any group of patients with cardiac arrest.

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