Comparison of exertion required to perform standard and active compression-decompression cardiopulmonary resuscitation

Objective: Active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) utilizes a hand-held suction device with a pressure gauge that enables the operator to compress as well as actively decompress the chest. This new CPR method improves hemodynamic and ventilatory parameters when compared with standard CPR. ACD-CPR is easy to perform but may be more labor intensive. The purpose of this study was to quantify and compare the work required to perform ACD and standard CPR. Methods: Cardiopulmonary testing was performed on six basic cardiac life support- and ACD-trained St. Paul, MN fire-fighter personnel during performance of 10 min each of ACD and standard CPR on a mannequin equipped with a compression gauge. The order of CPR techniques was determined randomly with >1 h between each study. Each CPR method was performed at 80 compressions/min (timed with a metronome), to a depth of 1.5–2 inches, and with a 50% duty cycle. Results: Baseline cardiopulmonary measurements were similar at rest prior to performance of both CPR methods. During standard and ACD-CPR, respectively, rate-pressure product was 18.2 ± 3.0 vs. 23.8 ± 1.7 (×1000, P < 0.01); mean oxygen consumption 15.98 ± 2.29 vs. 20.07 ± 2.10 ml/kg/min or 4.6 ± 0.7 vs. 5.7 ± 0.6 METS (P < 0.01); carbon dioxide production 1115.7 ± 110 vs. 1459.1 ± 176 ml/min; respiratory exchange ratio 0.88 ± 0.04 vs. 0.92 ± 0.04 (P = NS); and minute ventilation 35.5 ± 5.1 vs. 45.6 ± 9.2 l/min (P < 0.01). Conclusions: Approximately 25% more work is required to perform ACD-CPR compared with standard CPR. Both methods require subanaerobic energy expenditure and can therefore be sustained for a sufficient length of time by most individuals to optimize resuscitation efforts. Due to the slightly higher work requirement, ACD-CPR may be more difficult to perform compared with standard CPR for long periods of time, particularly by individuals unaccustomed to the workload requirement of CPR, in general.