• Piritta Anniina Setälä, Ilkka Tapani Virkkunen, Antti Jaakko Kämäräinen, Heini Sisko Annamari Huhtala, Janne Severi Virta, Arvi Mikael Yli-Hankala, and Sanna Elisa Hoppu.
• Emergency Medical Services, Tampere University Hospital, Tampere, Finland.
• Emerg Med J. 2018 Jul 1; 35 (7): 428-432.

BackgroundActive compression-decompression (ACD) devices have enhanced end-tidal carbon dioxide (ETCO2) output in experimental cardiopulmonary resuscitation (CPR) studies. However, the results in out-of-hospital cardiac arrest (OHCA) patients have shown inconsistent outcomes, and earlier studies lacked quality control of CPR attempts. We compared manual CPR with ACD-CPR by measuring ETCO2 output using an audiovisual feedback defibrillator to ensure continuous high quality resuscitation attempts.Methods10 witnessed OHCAs were resuscitated, rotating a 2 min cycle with manual CPR and a 2 min cycle of ACD-CPR. Patients were intubated and the ventilation rate was held constant during CPR. CPR quality parameters and ETCO2 values were collected continuously with the defibrillator. Differences in ETCO2 output between manual CPR and ACD-CPR were analysed using a linear mixed model where ETCO2 output produced by a summary of the 2 min cycles was included as the dependent variable, the patient as a random factor and method as a fixed effect. These comparisons were made within each OHCA case to minimise confounding factors between the cases.ResultsMean length of the CPR episodes was 37 (SD 8) min. Mean compression depth was 76 (SD 1.3) mm versus 71 (SD1.0) mm, and mean compression rate was 100 per min (SD 6.7) versus 105 per min (SD 4.9) between ACD-CPR and manual CPR, respectively. For ETCO2 output, the interaction between the method and the patient was significant (P<0.001). ETCO2 output was higher with manual CPR in 6 of the 10 cases.ConclusionsThis study suggests that quality controlled ACD-CPR is not superior to quality controlled manual CPR when ETCO2 is used as a quantitative measure of CPR effectiveness.Trial Registration NumberNCT00951704; Results.© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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