To the Editor.
—The study by Cohen et al1 on active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) represents the first new variation of CPR in many years. However, several points concerning this modification of standard CPR need attention. The authors present no data on complications from actively decompressing the chest wall with the ACD device. It would have been useful if the authors had autopsies performed on all patients receiving CPR, with specific attention directed to the thoracic cavity. Active compression-decompression with the ACD device may produce more trauma to the sternum than standard chest compressions alone. Unfortunately, the study's design and sample size does not allow for an adequate comparison of complications between ACD CPR and standard CPR. We would caution the use of this device until such data are available.While the investigators demonstrated improvement in several hemodynamic variables with ACD CPR, they failed to show an improvement
Sack JB, Gerber RS, Kesselbrenner MB. Active Compression-Decompression Cardiopulmonary Resuscitation. JAMA. 1992;268(22):3200-3201. doi:10.1001/jama.1992.03490220044023