Abstract | OBJECTIVE: DATA SOURCES: Medline and Embase were searched from inception to September 2013. STUDY SELECTION: DATA EXTRACTION: Data on study characteristics, including patients, intervention details, and outcome measures, were independently extracted. DATA SYNTHESIS: Fifteen trials, including 16,088 patients, were identified from 331 potentially relevant references. Return of spontaneous circulation was designated as the primary outcome. The pooled result showed no significant improvement in return of spontaneous circulation by active compression- decompression resuscitation or impedance threshold device in comparison with standard cardiopulmonary resuscitation (risk ratio, 1.04; 95% CI, 0.93-1.16; I, 46%). There was also no significant difference in survival or neurologic outcome at hospital discharge between active compression- decompression resuscitation or impedance threshold device and standard cardiopulmonary resuscitation. The meta-regression indicated that this minimal effect might be modified by two important prognostic factors, that is, witnessed status and response time. After adjustment of these two factors, impedance threshold device appeared to improve return of spontaneous circulation, which could be further augmented by advanced airway use. CONCLUSIONS: Active compression- decompression resuscitation or impedance threshold device seemed not to improve return of spontaneous circulation in out-of-hospital cardiac arrest patients. The meta-regression indicated two probable prognostic factors causing this minimal effect. Nonetheless, these findings referred to differences between trials and could not necessarily be extrapolated to individual patients. The individual patient-level extrapolation may need to be solved by a future randomized controlled trial.
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Authors | Chih-Hung Wang, Min-Shan Tsai, Wei-Tien Chang, Chien-Hua Huang, Matthew Huei-Ming Ma, Wen-Jone Chen, Cheng-Chung Fang, Shyr-Chyr Chen, Chien-Chang Lee |
Journal | Critical care medicine
(Crit Care Med)
Vol. 43
Issue 4
Pg. 889-96
(Apr 2015)
ISSN: 1530-0293 [Electronic] United States |
PMID | 25517475
(Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)
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Topics |
- Cardiopulmonary Resuscitation
(methods)
- Electric Impedance
- Humans
- Out-of-Hospital Cardiac Arrest
(therapy)
- Resuscitation
(methods)
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