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The Cochrane Database of Systematic... 2004Active compression-decompression cardiopulmonary resuscitation (ACDR CPR) uses a hand-held suction device, applied mid sternum, to compress the chest then actively... (Review)
Review
BACKGROUND
Active compression-decompression cardiopulmonary resuscitation (ACDR CPR) uses a hand-held suction device, applied mid sternum, to compress the chest then actively decompress the chest after each compression. Randomised controlled trials on use of active compression decompression cardiopulmonary resuscitation have results which are discordant.
OBJECTIVES
To determine clinical effects and safety of active compression-decompression cardiopulmonary resuscitation compared with standard manual cardiopulmonary resuscitation (STR).
SEARCH STRATEGY
We searched the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE. Last search was conducted in January 2004. We checked the reference list of retrieved articles and contacted enterprises manufacturing the active decompression devices.
SELECTION CRITERIA
All randomised or quasi-randomised studies comparing active compression-decompression cardiopulmonary resuscitation compared with standard manual cardiopulmonary resuscitation in adults with a cardiac arrest who received cardiopulmonary resuscitation by a trained medical or paramedical team.
DATA COLLECTION AND ANALYSIS
Data were independently extracted. All data were analysed on an intention-to-treat basis. The authors of the primary studies were contacted for more information when needed. Studies were cumulated, if appropriate, and pooled relative risk (RR) estimated. Subgroup analysis according to setting (out of hospital or in hospital) and attending team composition (with physician or paramedic only) were predefined.
MAIN RESULTS
Ten trials were included: eight were in out-of-hospital settings, one set in-hospital only and one had both in-hospital and out-of-hospital components. Allocation concealment was adequate in 4 trials. The two in-hospital studies were very different in quality (A and C) and size (773 and 53 patients). Both found no differences between ACDR CPR and STR in any outcome. Trials conducted in out-of-hospital settings cumulated 4162 patients. There were no differences between ACDR CPR and STR for mortality either immediately (RR 0.98 [95% CI 0.94 - 1.03]) or at hospital discharge (RR 0.99 [95% CI 0.98 - 1.01]). The pooled RR of neurological impairment, any severity, was 1.71 [95% CI 0.90 - 3.25], with a non-significant trend to more frequent severe neurological damage in survivors of ACDR CPR (RR 3.11 [95% CI 0.98 - 9.83]). However, assessment of neurological outcome was limited and there were few patients with neurological damage. There was no difference between ACDR CPR and STR with regard complications such as rib or sternal fractures, pneumothorax or hemothorax (RR 1.09 [95% CI 0.86 - 1.38]). Skin trauma and ecchymosis were more frequent with ACDR CPR.
REVIEWERS' CONCLUSIONS
Active chest compression-decompression in patients with cardiac arrest is not associated with clear benefit.
Topics: Adult; Cardiopulmonary Resuscitation; Emergency Medical Services; Heart Arrest; Humans; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 15106176
DOI: 10.1002/14651858.CD002751.pub2 -
The Cochrane Database of Systematic... 2002Active compression-decompression cardiopulmonary resuscitation (ACDR CPR) uses a hand-held suction device, applied mid sternum, to compress the chest then actively... (Review)
Review
BACKGROUND
Active compression-decompression cardiopulmonary resuscitation (ACDR CPR) uses a hand-held suction device, applied mid sternum, to compress the chest then actively decompress the chest after each compression. Randomised controlled trials on use of active compression decompression cardiopulmonary resuscitation have results which are discordant.
OBJECTIVES
To determine clinical effects and safety of active compression-decompression cardiopulmonary resuscitation compared with standard manual cardiopulmonary resuscitation (STR).
SEARCH STRATEGY
We searched the Cochrane Controlled Trials Register (May 2002), MEDLINE and EMBASE. We checked the reference list of retrieved articles and contacted enterprises manufacturing the active decompression devices.
SELECTION CRITERIA
All randomised or quasi-randomised studies comparing active compression-decompression cardiopulmonary resuscitation compared with standard manual cardiopulmonary resuscitation in adults with a cardiac arrest who received cardiopulmonary resuscitation by a trained medical or paramedical team.
DATA COLLECTION AND ANALYSIS
Data were independently extracted. All data were analysed on an intention-to-treat basis. The authors of the primary studies were contacted for more information when needed. Studies were cumulated, if appropriate, and pooled relative risk (RR) estimated. Subgroup analysis according to setting (out of hospital or in hospital) and attending team composition (with physician or paramedic only) were predefined.
MAIN RESULTS
Twelve trials were included: 10 were in out-of-hospital settings, one set in-hospital only and one had both in-hospital and out-of-hospital components. Allocation concealment was adequate in 4 trials. The two in-hospital studies were very different in quality (A and C) and size (773 and 53 patients). Both found no differences between ACDR CPR and STR in any outcome. Trials conducted in out-of-hospital settings cumulated 4162 patients. There were no differences between ACDR CPR and STR for mortality either immediately (RR 0.98 [95% CI 0.94 - 1.03]) or at hospital discharge (RR 0.99 [95% CI 0.98 - 1.01]). The pooled RR of neurological impairment, any severity, was 1.71 [95% CI 0.90 - 3.25], with a non-significant trend to more frequent severe neurological damage in survivors of ACDR CPR (RR 3.11 [95% CI 0.98 - 9.83]). However, assessment of neurological outcome was limited and there were few patients with neurological damage. There was no difference between ACDR CPR and STR with regard complications such as rib or sternal fractures, pneumothorax or hemothorax (RR 1.09 [95% CI 0.86 - 1.38]). Skin trauma and ecchymosis were more frequent with ACDR CPR.
REVIEWER'S CONCLUSIONS
Active chest compression-decompression in patients with cardiac arrest is not associated with clear benefit.
Topics: Adult; Cardiopulmonary Resuscitation; Heart Arrest; Humans; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 12137656
DOI: 10.1002/14651858.CD002751 -
The Cochrane Database of Systematic... 2001Active compression-decompression cardiopulmonary resuscitation (ACD CPR) uses a hand-held suction device, applied mid sternum, to compress the chest then actively... (Review)
Review
BACKGROUND
Active compression-decompression cardiopulmonary resuscitation (ACD CPR) uses a hand-held suction device, applied mid sternum, to compress the chest then actively decompress the chest after each compression. Randomised controlled trials on use of active compression decompression cardiopulmonary resuscitation have results which are discordant.
OBJECTIVES
To determine clinical effects and safety of active compression-decompression cardiopulmonary resuscitation compared with standard manual cardiopulmonary resuscitation (STR).
SEARCH STRATEGY
We searched the Cochrane Heart Group Specialised register (April 2001), the Cochrane library, MEDLINE and EMBASE. We checked the reference list of retrieved articles and contacted enterprises manufacturing the active decompression devices.
SELECTION CRITERIA
All randomized or quasi-randomized studies comparing active compression-decompression cardiopulmonary resuscitation compared with standard manual cardiopulmonary resuscitation in adults with a cardiac arrest who received cardiopulmonary resuscitation by a trained medical or paramedical team.
DATA COLLECTION AND ANALYSIS
Data were independently extracted. All data were analysed on an intention-to-treat basis. The authors of the primary studies were contacted for more information when needed. Studies were cumulated, if appropriate, and pooled relative risk (RR) estimated. Subgroup analysis according to setting (out of hospital or in hospital) and attending team composition (with physician or paramedic only) were predefined.
MAIN RESULTS
Twelve trials were included: 10 were in out-of-hospital settings, one set in-hospital only and one had both in-hospital and out-of-hospital components. Allocation concealment was adequate in 4 trials. The two in-hospital studies were very different in quality (A and C) and size (773 and 53 patients). Both found no differences between ACD CPR and STR in any outcome. Trials conducted in out-of-hospital settings cumulated 4162 patients. There were no differences between ACD CPR and STR for mortality either immediately (RR 0.98 [95% CI 0.94 - 1.03]) or at hospital discharge (RR 0.99 [95% CI 0.98 - 1.01]). The pooled RR of neurological impairment, any severity, was 1.71 [95% CI 0.90 - 3.25], with a non-significant trend to more frequent severe neurological damage in survivors of ACD CPR (RR 3.11 [95% CI 0.98 - 9.83]). However, assessment of neurological outcome was limited and there were few patients with neurological damage. There was no difference between ACD CPR and STR with regard complications such as rib or sternal fractures, pneumothorax or hemothorax (RR 1.09 [95% CI 0.86 - 1.38]). Skin trauma and ecchymosis were more frequent with ACD CPR.
REVIEWER'S CONCLUSIONS
Active chest compression-decompression in patients with cardiac arrest is not associated with clear benefit.
Topics: Adult; Cardiopulmonary Resuscitation; Heart Arrest; Humans; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 11687024
DOI: 10.1002/14651858.CD002751 -
AJR. American Journal of Roentgenology Mar 1985Thoracic sarcoidosis is a common disease, and its usual radiographic manifestations have been well described and are readily recognized. However, most physicians are not... (Review)
Review
Thoracic sarcoidosis is a common disease, and its usual radiographic manifestations have been well described and are readily recognized. However, most physicians are not familiar with the unusual and often confusing manifestations of thoracic sarcoid, which have been sporadically reported. Using information derived from a systematic review of the literature and clinical material from our own institutions, a classification has been developed of the unusual thoracic manifestations of sarcoidosis, and their relative incidence has been determined and tabulated. These include lesions of the osseous, pleural, mediastinal, hilar, bronchial, pulmonary parenchymal, vascular, and cardiac structures. The information presented in this review is intended to provide physicians with a single comprehensive source to assist them when atypical radiographic findings of thoracic sarcoidosis are a diagnostic consideration.
Topics: Bronchial Diseases; Bronchiectasis; Calcinosis; Cardiomegaly; Chylothorax; Constriction, Pathologic; Humans; Lymphatic Diseases; Mediastinal Emphysema; Pleura; Pleural Effusion; Pneumothorax; Pulmonary Atelectasis; Radiography; Ribs; Sarcoidosis; Sternum; Thoracic Diseases; Thoracic Vertebrae; Tracheal Diseases; Vascular Diseases
PubMed: 3155892
DOI: 10.2214/ajr.144.3.513