[Clinical effect of cardiopulmonary resuscitation with active abdominal compression-decompression]

Abstract

Objective: To explore the resuscitation effect of active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) on patients with cardiac arrest.

Methods: The patients with cardiac arrest admitted to emergency medical center of Hainan General Hospital from June 2014 to January 2016 were enrolled, who were satisfied with the indication of AACD-CPR and had no contraindication for AACD-CPR, and with 40-150 kg weight and over 16 years old. All of enrolled patients were given mechanical ventilation and conventional drug rescue. At the same time, AACD-CPR was performed with the active abdominal compression-decompression device, the rhythm of abdominal compression-decompression was 100 bmp and the ratio of compression time to lift time was 1:1, the pressure intensity was approximately 50 kg and the lifting intensity was approximately 30 kg. Heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO₂) and blood lactic acid (Lac) were recorded before and after CPR, and restoration of spontaneous circulation (ROSC) were calculated.

Results: Forty-one patients with cardiac arrest were enrolled, with 22 males and 19 females, and the age between 15 years old and 89 years old, with an average (66.5±18.8) years old. The etiologies of cardiac arrest were followed: cardiogenic for 10 cases, non-cardiogenic for 18 cases, and unknown causes for 13 cases. The rate of ROSC in patients with AACD-CPR was 19.5% (8/41). During the resuscitation, the HR, MAP and SpO₂ of those patients were significantly improved compared with those index suffering the cardiac arrest [HR (bmp): 67.0 (48.0, 105.0) vs. 0.0 (0.0, 11.5), MAP (mmHg, 1 mmHg = 0.133 kPa): 23.0 (16.0, 37.0) vs. 0.0 (0.0, 0.0), SpO₂: 0.79 (0.45, 0.90) vs. 0.00 (0.00, 0.32), all P < 0.01]. During the resuscitation and 0.5 hours after ROSC, the indexes of the ROSC patients were significantly improved compared with those suffering cardiac arrest [HR (bmp): 88.5 (53.8, 105.0), 94.5 (72.5, 129.3) vs. 0.0 (0.0, 17.3); MAP (mmHg): 48.0 (41.3, 66.0), 54.0 (42.0, 72.5) vs. 0.0 (0.0, 0.0); SpO₂: 0.74 (0.64, 0.80), 0.89 (0.81, 0.93) vs. 0.00 (0.00, 0.42); all P < 0.05]; in addition, the Lac of patients was not increased in the resuscitation and 0.5 hours after ROSC compared with the status before cardiopulmonary resuscitation (mmol/L: 4.44±1.66, 3.71±1.33 vs. 3.95±1.71, both P > 0.05). Besides, the ROSC rate of patients who suffered cardiac arrest before pre-hospital care or in emergency ward [11.1% (2/18)] were lower than those the patients who suffered cardiac arrest in emergency intensive care unit [EICU, 26.1% (6/23)]; while the cardiac arrest patients who didn't experienced AACD-CPR until they got complications such as thoracic rib fracture after standard cardiopulmonary resuscitation (STD-CPR), the ROSC rate of those patients in pre-hospital care or in emergency ward [10.0% (1/10)] were lower than the ROSC rate of the patients who suffered cardiac arrest in EICU [20.0% (4/20)], but there was no significant difference between the two groups (both P > 0.05).

Conclusions: AACD-CPR is effective in the treatment of sudden cardiac arrest patients with contraindication of chest compression, and makes up for the deficiency of STD-CPR.