The Ontario trial of active compression-decompression cardiopulmonary resuscitation for in-hospital and prehospital cardiac arrest

Objective.-To 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. Design.-Randomized 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. Patients.-A total of 1784 adults who had cardiac arrest, Intervention.-Patients received either standard or ACD CPR throughout resuscitation. Main Outcome Measures.-Survival for 1 hour and to hospital discharge and the modified Mini-Mental State Examination (MMSE). Results.-All 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. Conclusions.-ACD CPR did not improve survival or neurologic outcomes in any group of patients with cardiac arrest.