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January 15, 1992

Survival From In-Hospital Cardiac Arrest With Interposed Abdominal Counterpulsation During Cardiopulmonary Resuscitation

Author Affiliations

From the Departments of Medicine (Drs Sack and Kesselbrenner) and Surgery (Dr Bregman), Seton Hall University School of Graduate Medical Education, St Joseph's Hospital and Medical Center, Paterson, NJ. Dr Sack is now with the Division of Cardiology, UCLA Medical Center.

JAMA. 1992;267(3):379-385. doi:10.1001/jama.1992.03480030057037

Objective.  —To determine whether interposed abdominal counterpulsation (IAC) during standard cardiopulmonary resuscitation (CPR) improves outcome in patients experiencing in-hospital cardiac arrest.

Design and Setting.  —Randomized controlled trial in a university-affiliated hospital.

Patients.  —Patients experiencing in-hospital cardiac arrest during a 6-month period.

Interventions.  —Patients were randomized to receive either IAC during CPR or standard CPR in the event of cardiac arrest. Abdominal compressions were performed during the relaxation phase of chest compression, corresponding to CPR diastole, at a rate of 80/min to 100/min.

Main Outcome Measures.  —The three end points studied were (1) return of spontaneous circulation, (2) survival 24 hours after resuscitation, and (3) survival to hospital discharge. In addition, we examined neurological outcome in those patients surviving to hospital discharge.

Results.  —During the study period there were 135 resuscitation attempts in 103 patients. Return of spontaneous circulation was significantly greater in the group receiving IAC during CPR than in the group receiving standard CPR (51% vs 27%, P=.007). At hospital discharge, a significantly greater proportion of patients was alive in the IAC group than in the control group (25% vs 7%, P=.02). Eight (17%) of 48 patients who received IAC during CPR survived to hospital discharge neurologically intact, compared with only three (6%) of 55 patients from the standard CPR group (not significant).

Conclusions.  —We conclude that the addition of IAC to standard CPR may improve meaningful survival following in-hospital cardiac arrest. The optimal use of this technique awaits further clinical trials.(JAMA. 1992;267:379-385)