Safety, feasibility, and hemodynamic and blood flow effects of

active compression– decompression of thorax and abdomen in

patients with cardiac arrest*
Christof Havel, MD; Andrea Berzlanovich, MD; Fritz Sterz, MD; Hans Domanovits, MD; Harald Herkner, MD;
Andrea Zeiner, MD; Wilhelm Behringer, MD; Anton N. Laggner, MD

Objective: During closed chest compression for cardiac arrest, Measurements and Main Results: We evaluated the safety,
any increase in coronary perfusion pressure accounts for a pro- feasibility, and hemodynamic effects of both interventions and
portional increase in myocardial blood flow and therefore the observed, with the help of echocardiography, the mechanisms
resuscitability of the patient. The objectives of this study were to through which blood flow was generated. We found no significant
evaluate the safety, feasibility, and hemodynamic effects of difference between the use of the Lifestick device and standard
phased chest and abdominal compression– decompression and to chest compression with the Thumper device in resuscitations.
compare it with mechanical chest compression during cardiopul- Most operators regarded the Lifestick as a feasible alternative to
monary resuscitation. the Thumper. We could observe a mean increase in coronary
Design: In this prospective, single-center, phase II study, we perfusion pressure of 9.33 mm Hg (interquartile range, 1.96 –
compared patients treated with the Datascope Lifestick Resusci- 14.36; p ⴝ .08) and an increase of end-tidal CO2 of 10 mm Hg
tator with patients who had been treated with mechanical pre- (interquartile range, 5–16; p ⴝ .003) (1333Pa [interquartile range,
cordial compression. 665–2133]) during resuscitation with the Lifestick compared with
Setting: Emergency department of a tertiary care university using the Thumper.
hospital. Conclusion: In this preliminary study, resuscitation with
Patients: We included 31 patients with cardiac arrest who had the Lifestick was found to be safe and feasible. The design of
received cardiopulmonary resuscitation in the emergency depart- the study and small number of patients included in it limit the
ment. conclusions about the hemodynamic effects of the Lifestick.
Interventions: The Lifestick device was used in 20 patients. In (Crit Care Med 2008; 36:1832–1837)
11 patients, mechanical chest compression with the Thumper KEY WORDS: cardiopulmonary resuscitation; death; sudden;
device was used as a control intervention. echocardiography

C losed chest compression has equate myocardial perfusion for cardiac abdomen was described to yield maximal
remained the standard for hu- resuscitation. Myocardial blood flow is coronary and carotid perfusion (19 –21).
man resuscitation (1–3) since highly correlated with the coronary per- This concept was refined by a modeling
the 1960 landmark study by fusion pressure (7–10) (i.e., the pressure study of Lin et al (22). Based on this
Kouwenhoven et al (4, 5). Crile and Dol- gradient between the aorta and the right study, the Lifestick resuscitator was de-
ley (6) recognized the importance of ad- atrium during compression diastole). An veloped (23).
increase in coronary perfusion pressure The objectives of this study were to
leads to a corresponding increase in myo- evaluate the safety, feasibility, and he-
*See also p. 1974. cardial blood flow and therefore enhances modynamic effects (with additional
From the Departments of Emergency Medicine
(CH, FS, HD, HH, AZ, WB, ANL) and Forensic Medicine
the resuscitability of a patient (9, 11, 12). echocardiographic analyses) of sequen-
(AB), Medical University of Vienna, Vienna General The report of a successful cardiopul- tial active compression– decompression
Hospital, Vienna, Austria. monary resuscitation using a toilet of the thorax and abdomen with the
The authors have not disclosed any potential con- plunger was the trigger for the develop- Lifestick resuscitator (Datascope Cor-
flicts of interest. ment of a suction cup, which produces poration, Fairfield, NJ) during human
Supported, in part, by grants from the Austrian
Science Foundation (P11405-MED) and by an unre- not only active chest compressions but cardiopulmonary resuscitation in a
stricted grant from Datascope Cardiac Assist Division, also decompressions (13). In subsequent clinical setting.
Fairfield, NJ. Robert B. Schock (Datascope Corpora- animal experiments (14, 15), and later in
tion, Cardiac Assist Division, Fairfield, NJ) provided human cardiac arrest studies (14, 16, 17),
technical support and the Lifestick. MATERIALS AND METHODS
For information regarding this article, E-mail:
the beneficial hemodynamic effects of ac-
[email protected] tive compression and decompression In this prospective (not randomized, not
Copyright © 2008 by the Society of Critical Care were clearly demonstrated (18). blinded), single-center, phase II study in
Medicine and Lippincott Williams & Wilkins Active out-of-phase compression and which we compared patients receiving 5 mins
DOI: 10.1097/CCM.0b013e3181760be0 decompression both of the thorax and of mechanical chest compression (Thumper

1832 Crit Care Med 2008 Vol. 36, No. 6

1000, Michigan Instruments, Grand Rapids, sive-backed pads (one pad each for adhesion to Thumper resuscitation groups for the safety
MI) (8) with patients who received 10 mins of the sternum and abdomen). The device incor- analysis. For the analysis on hemodynamic ef-
“treatment” with the Lifestick. To assess the porates force monitoring and a metronome to fects, a one-sample Wilcoxon’s test was used to
safety of the Lifestick, we also included in the facilitate the delivery of optimal forces and allow for the paired nature of data. SPSS (SPSS,
study patients who were only treated with me- timing of load application. Mechanical chest Chicago, IL) for Windows was used for data anal-
chanical chest compression (Thumper) under compression in the control group was per- ysis. A two-sided p value of ⬍.05 was considered
identical circumstances. Ethics committee ap- formed by an automatic chest compression as statistically significant.
proval was obtained before commencement device (Thumper) that delivered 4 –5 cm of
of the study; informed consent was waived deflection (40 – 60 kg of force) at a rate of 80 RESULTS
compressions/min and a compression/ventila-
pursuant to the Declaration of Helsinki,
tion ratio of 5:1. The compression duty cycle The study was 10 months in duration.
Section II.5.
was 50% and not interrupted for ventilation. During this period, 214 cardiac arrest pa-
Subjects. Patients for this study were se-
Safety Criteria. Safety was evaluated by tients were admitted to the emergency
lected from the population served by our de-
assessment and analysis of adverse events in department, out of which 31 patients
partment of emergency medicine at a tertiary
patients treated with the Lifestick by means of could be included in the study. Treat-
care university hospital (24). Patients ⬎18 yrs
autopsies following predefined criteria. ment with thoracoabdominal compres-
of age presenting to the emergency depart-
Feasibility. After the completion of resus-
ment in nontraumatic, normothermic, wit- sion– decompression Lifestick resuscita-
citation with the Lifestick, the operator of the
nessed cardiopulmonary arrest were eligible tion was applied to 20 patients. To assess
Lifestick device completed a questionnaire,
for inclusion into this study. The specific in- the safety of the Lifestick, 11 patients
which included the ability of the device to
clusion criteria were: continued cardiac arrest were prospectively selected for mechani-
deliver appropriate forces and pad adhesion to
and absence of pulse and blood pressure de- cal chest compression with the Thumper.
the skin.
spite ⱖ10 mins of standard advanced cardiac
Hemodynamic Measurements. Two pigtail The demographic data for both groups
life support— defined as coronary perfusion
catheters (Cordis Corporation, Miami, FL) are presented in Table 1. There were no
pressure of ⬍15 mm Hg or end-tidal CO2
were inserted percutaneously, one via the fem- significant differences among the pa-
pressure of ⬍15 mm Hg (1200 Pa), or both.
oral artery and one via the femoral vein, to tients with regard to most variables; the
Patients with known terminal conditions,
obtain aortic and right atrial pressures. A cor- only exception was the cause of their car-
chronic mental or physical disabilities, hemo-
onary perfusion pressure analysis was per-
dialysis treatment, or midline sternotomy diac arrest.
formed by using the area under the curve
scars were not included. In patients receiving Lifestick resusci-
(aortic minus venous pressure) during dias-
All patients were managed in accordance tation, the median time that had elapsed
tole. Diastole was defined as the time during
with the guidelines of the American Heart from their collapse until the application
which no chest compression was carried out.
Association and conventional medical man- of the Lifestick resuscitator was 52 mins
Using interval frames of 4 secs for on-line
agement of the department of emergency
calculations with various filter techniques and (34 –78 mins). None of these patients sur-
medicine, regardless of which type of external
cardiac compression was applied (2, 24).
signal processing features (windowing of sig- vived. The compression force applied dur-
nal, differential, and fast Fourier transform ing mechanical chest compression with
Volume-controlled ventilation (Servo Ven-
algorithm) on the coronary perfusion pressure the Thumper was 55 kg (50 – 60 kg), fol-
tilator 300, Siemens-Elema AB, Life Support
result, it was possible to extract exactly defined lowed by 54 kg (49 – 61 kg) in the Life-
Systems Division, Solina, Sweden) was set at
parts of the signal and evaluate the blood
an FIO2 of 1.0, tidal volume of 10 mL/kg body stick resuscitation phase.
pressure within the coronary arteries during
weight, respiratory rate of 15 breaths/min, and Safety Criteria. Adverse events as de-
external chest compression.
ventilation pressure limit of 50 mm Hg. termined by autopsy are presented in Ta-
Transesophageal Echocardiography. In
Cardiopulmonary Resuscitation. While ble 2. None of the patterns reached sta-
patients receiving Lifestick resuscitation,
standard advanced cardiac life support was be- tistical significance between the groups.
transesophageal echocardiography was per-
ing performed, a special Lifestick code team
formed with a HP Sonos 2500 (Hewlett- Feasibility. The operators’ ratings of
prepared for the trial of standard cardiopul-
monary resuscitation and Lifestick resuscita-
Packard, Palo Alto, CA) using a biplane trans- the ability to deliver appropriate forces
esophageal echocardiography probe according during thoracoabdominal compression–
tion. Thoracoabdominal compression– decom-
to the guidelines of the American Society of decompression Lifestick resuscitation
pression Lifestick resuscitation was performed
Echocardiography (25). All examinations were and of the adhesion of the pads to the
by means of a hand-held and manually oper-
performed by two investigators trained and
ated device (Fig. 1) by a specially trained Life- skin are presented in Figures 2 and 3.
experienced in this ultrasound technique. A
stick code team. The device consists of a single Overall, the feasibility of using the Life-
force curve of the Lifestick resuscitator was
rigid frame attached to two disposable adhe- stick was rated as easy and very good by
displayed on the ultrasound screen in addition
to echocardiographic tracings to allow for the majority of operators.
time phasing of the echo with the resuscita- Hemodynamic Measurements. In five
tion cycles. The variables selected for this patients, the arterial and venous cathe-
study were: 1) ventricular deformation during ters could be correctly placed in the aor-
the compression phase of cardiopulmonary re- tic arch and right atrium, respectively.
suscitation, 2) mitral valve position during the Mean increase in coronary perfusion
compression phase of cardiopulmonary resus- pressure was 9.33 mm Hg (1.96 –14.36,
citation, 3) transmitral flow during the com- p ⫽ .08). In all but one patient, the cor-
pression phase of cardiopulmonary resuscita-
onary perfusion pressure increased dur-
tion, and 4) aortic valve position.
Statistics. The data are presented as median ing Lifestick resuscitation (Fig. 4).
and the interquartile range or number and per- The end-tidal CO2 pressure was deter-
centage, where appropriate. Fisher’s exact test mined in 15 patients. The mean values
Figure 1. Thoracoabdominal compression– decom- and the Mann-Whitney U test were used to test are presented in Figure 5. We could ob-
pression Lifestick resuscitator. for differences between the Lifestick and serve an increase in end-tidal CO2 pres-

Crit Care Med 2008 Vol. 36, No. 6 1833

Table 1. Demographic data resuscitation, the mitral valve was open
during the compression phase in three
Lifestick, n ⫽ 20 Thumper, n ⫽ 11
patients and closed in eight patients. In one
Age (years), median (IQR) 61 (49–71) 65 (50–71)
patient, the valve was open during chest
Female gender, n (%) 6 (30) 6 (55) compression with the Thumper and closed
Height (m), median (IQR) 1.70 (1.63–1.79) 1.72 (1.62–1.77) during Lifestick resuscitation. Quantitative
Weight (kg), median (IQR) 80 (74–90) 68 (62–90) Doppler flow over the mitral valve (Table 3)
Pre-arrest status (OPCa), median (IQR) 1.0 (1.0–1.3) 1.0 (1.0–1.0) could be measured only in three patients
Medical history
Smoker, n (%) 7 (35) 2 (18) during chest compression with the
Diabetes, n (%) 3 (15) 1 (9) Thumper and in 11 patients during Life-
Heart disease, n (%) 9 (45) 5 (45) stick resuscitation. During abdominal com-
Skin dampness, n (%) 11 (55) 8 (73) pression, atrioventricular reflux in the be-
Moderate or severe hirsute, n (%) 4 (20) 2 (18)
Initial cardiac rhythm
ginning of the compression phase, then
Asystole, n (%) 7 (35) 2 (18) antegrade flow from the left atrium to the
Pulsless electric activity, n (%) 5 (25) 4 (36) left ventricle in the mid-compression
Ventricular fibrillation, n (%) 8 (40) 5 (45) phase, and finally, another bout of ante-
Total defibrillation energy J, median grade flow from the left atrium to the left
(IQR)
Prehospital 2660 (1,000–4,505) 2360 (1,700–3,680)
ventricle in the early decompression phase
In-hospital prior Lifestick/prior 1360 (960–1,960) 2020 (1,440–4,650) was observed. One patient had exclusively
inclusion antegrade flow from the left atrium to the
In-hospital during Lifestick/after 960 (720–4,560) 2520 (1,460–5,400) left ventricle during the thoracic compres-
inclusion sion phase of chest compression with the
Total amount of epinephrine mg, Thumper. The velocity–time integral of an-
median (IQR)
Prehospital 8 (4–12) 9 (7–11)
tegrade atrioventricular flow was .174
In-hospital prior Lifestick/prior 2 (1–2) 2 (2–2) m/sec (.147–.181 m/sec). The aortic valve
inclusion opened, with forward aortic flow during
In-hospital during Lifestick/after 2 (1–2) 1 (1–2) chest compression, in all patients studied.
inclusion
Cause of cardiac arrestb
Myocardial infarction, n (%) 14 (70) 2 (20) DISCUSSION
Pulmonary embolism, n (%) 2 (10) 1 (10)
Miscellaneous, n (%) 4 (20) 7 (70) Four-phase thoracoabdominal compres-
sion– decompression resuscitation with the
a
Overall performance category; bthe cause of cardiac arrest was in each case confirmed by autopsy. Lifestick, a technique combining the effects
IQR, interquartile range. of interposed abdominal compression (26)
Table 2. Adverse events as determined by autopsy and active compression– decompression
(14) cardiopulmonary resuscitation is fea-
Lifestick Controls to Assess Safety sible and easily accepted by users after a
n ⫽ 20 n ⫽ 11 p
brief period of training. Injuries due to car-
Bilateral rib fracture – n/n (%) 16/20 (80) 9/11 (75) .36
diopulmonary resuscitation, such as rib
Number of fractured ribs – median (IQR) 8 (5–12) 6 (5–10) .56 fractures or internal bruising, as deter-
Sternum fracture – n/n (%) 16/18 (89) 7/10 (64) .19 mined by autopsy, were not significantly
Liver rupture – n/n (%) 1/20 (5) 0/0 1.00 different for Lifestick resuscitation and me-
Gastric dilation – n/n (%) 5/20 (25) 3/10 (30) .32 chanical chest compression with the
Skin abrasion – n/n (%) 13/18 (72) 10/11 (91) .20
Skin contusion – n/n (%) 3/18 (18) 1/11 (9) .39 Thumper only. Although all patients had
prolonged cardiopulmonary resuscitation,
IQR, interquartile range. Lifestick resuscitation seemed to improve
hemodynamic effects compared with me-
chanical chest compression with the
sure of 10 mm Hg (5–16, p ⫽ .003) (1333 thoracoabdominal compression– decom- Thumper only. The few transesophageal
Pa [665–2133]) during Lifestick resusci- pression Lifestick resuscitation, the right echocardiographic observations point to
tation. atrium and ventricle were almost com- the conclusion that in most patients, the
Transesophageal Echocardiographic pletely compressed and thus evacuated effectiveness of blood flow mechanisms and
Observations. Transesophageal echocar- during the compression phase in all pa- the thoracic and cardiac pump mechanism
diography was performed on five patients tients. Also, the left ventricle appeared (27, 28) are mutually dependent on each
during mechanical chest compression empty, although to a lesser extent than other.
with the Thumper and on 11 patients the right ventricle. We made no attempts Standard manual chest compression
during resuscitation with the Lifestick. to measure the magnitude of the reduc- would be the appropriate technique with
The proposed variables could be analyzed tion of the left ventricle. During chest which the Lifestick should be compared. To
only in a limited number of recordings compression with the Thumper, the mi- achieve accurate, consistent, and compara-
due to difficulties during the ongoing re- tral valve was open during the compres- ble pressures during chest compression, we
suscitation. During standard chest com- sion phase in two patients and closed in instead used mechanical chest compres-
pression with the Thumper and during three patients (Table 3). During Lifestick sion with the Thumper device as control

1834 Crit Care Med 2008 Vol. 36, No. 6

 sion Lifestick resuscitation and standard
chest compression Thumper resuscita-
tion alone (Table 2). Depending on the
definition of injuries and the quality of
the autopsy, the rate of reported injuries
varied between 21% and 65% (30). In a
series of 705 autopsies after conventional
resuscitation, thoracic complications of
various degrees were observed in 43% of
the cases. Rib fractures were found in
32% and sternal fractures in 21% of the
autopsies. In 18% of the cases, mediasti-
nal hemorrhages were observed. More-
over, abdominal injuries were described
Figure 2. Feasibility of the thoracoabdominal compression– decompression Lifestick resuscitation:
in 31% and pulmonary complications in
operators’ judgment of the ability to deliver appropriate forces during the use of the Lifestick 13%. In nearly 0.5% of the cases, the
resuscitator assessed by a questionnaire immediately after the procedure. injuries were categorized as life threaten-
ing (31). In this study, we found a high
rate of rib and sternal fractures, which is
in line with the findings reported else-
where (32, 33). However, there was no
indication of an increase in abdominal
lesions with the new technique.
Feasibility. The thoracoabdominal
compression– decompression Lifestick
resuscitation technique was easy to learn
and everyone on our team was able to
operate the device after a short period of
training. The device was well accepted
and the operators delivered appropriate
forces during thoracoabdominal com-
pression– decompression Lifestick resus-
Figure 3. Feasibility of the Lifestick resuscitation: judgment of the pad adhesion to the skin during the citation. The adhesion of the pads to the
use of the Lifestick resuscitator. skin was satisfactory. Lifestick users did
not complain about exhaustion or stren-
25 50 uous handling during the 10 mins of op-
mmHg mmHg eration. There were also no reports of
45
20 discomfort in the back or other com-
40
plaints by the operators. There were a few
15 35 reports of instability of the device because
30 of unsatisfactory fixation of the pads to
10 the skin (Fig. 3). No problems with re-
25
spect to defibrillation were reported. The
5 20
metronome giving the thoracic–abdomi-
15 nal phase shift was found to be useful. No
0 10 handling errors were observed.
mechanical chest lifestick Hemodynamic Effects and Mecha-
5
compression
nism of Blood Flow. There are two theo-
0
Figure 4. Mean coronary perfusion pressure ries about the mechanisms that generate
mechanical chest Lifestick
available from five patients, comparing mechan- blood flow. The cardiac pump theory pos-
compression
ical chest compression with Thumper (cardiopul- tulates direct compression of the heart be-
monary resuscitation) followed by thoracoab- Figure 5. Mean end-tidal CO2 pressure in 15 pa-
tients, comparing mechanical chest compression tween the sternum and spine. The thoracic
dominal compression– decompression phase with
with Thumper (cardiopulmonary resuscitation) fol- pump theory postulates that blood flow is
the Lifestick. The bold line represents the mean
of these five patients. lowed by thoracoabdominal compression– decom- caused by intrathoracic pressures exceed-
pression phase with the Lifestick. The bold line ing extrathoracic vascular pressure (27, 28,
represents the mean of these 15 patients. 34). Compression and decompression of ei-
intervention. This was considered better ther the chest or the abdomen can help to
then manual chest compression, even if the move blood during cardiac arrest. Negative
piston of the Thumper might somewhat mon for victims to receive injuries. Au- thoracic and positive abdominal pressures
hinder the relaxation phase (29). topsies of the patients have shown that prime the chest pump. Positive thoracic
Safety Criteria. Because of the force these have been comparable between tho- and negative abdominal pressures prime
necessary to circulate blood, it is com- racoabdominal compression– decompres- the abdominal pump (20).

Crit Care Med 2008 Vol. 36, No. 6 1835

Table 3. Transesophageal echocardiographic observations in patients receiving first mechanical chest compression with the Thumper followed by thoraco
abdominal compression-decompression Lifestick resuscitation

Thumper Lifestick

Patient # Age Rhythm Lifestick MVa Position AVb Regurgitation Antero-grade VTIc MVa Position AVb Regurgitation Antero-grade VTIc

1 79 Asystd — — — Closed Yes —

4 67 PEAe — — — Open No —
6 80 Asystd Open — — Closed Yes .188
7 64 VFf — — — Closed Yes .174
8 48 VFf — — — Open Yes .224
9 41 Asystd — — — Closed Yes —
10 77 Asystd — — — Closed Yes .128
11 70 VFf Closed Yes .158 Closed Yes —
14 57 Asystd Closed — — Closed Yes .174
16 57 PEAe Open No — Open Yes .148
17 70 PEAe Closed Yes — Closed Yes .146
a
mitral valve; batrioventricular; cmeasurements were performed in the beginning of the compression phase by means of color Doppler flow and
anterograde mitral velocity time integral in m/s (VTI); dasystole; epulsless electrical activity; fventricular fibrillation.

We could demonstrate a marked in- open mitral valve during compression un- ings as in our study with regard to the
crease in coronary perfusion pressure, der standard cardiopulmonary resuscita- hemodynamic effects and mechanisms of
which indicates that Lifestick resuscitation tion to closed mitral valve under Lifestick blood flow, and this without the optimal
does increase blood flow. Abdominal com- resuscitation. Because the arteriovenous combination of ventilation with the phased
pression, however, may increase arterial pressure difference remained unchanged, compressions and decompressions (39) and
and venous pressures via diaphragmatic we do not believe that this represents a the use of Lifestick resuscitation after pro-
motion but not actually increase perfusion substantial change in the blood flow mech- longed standard cardiopulmonary resusci-
in the coronaries. Thus, the calculated cor- anism. It could have been caused by in- tation. Therefore, future studies need to
onary perfusion pressure may not reflect creased compression force (37), changes in focus on the earlier application of this tech-
actual coronary perfusion if the aortic valve intrathoracic pressure (10), or application nique with different ventilation compres-
is open. Unfortunately, this is currently the of the compression forces to regions of the sion ratios. The reports with regard to the
only way to arrive at an estimate of coro- chest wall that were overlying the heart operation of the phased chest and abdomi-
nary perfusion pressure in real life. (38). However, we did not observe any dif- nal compression– decompression tech-
Animal and human data (34, 35) dem- ferences in pressure forces in our study. nique confirm our findings of its feasibility.
onstrated that a reduction in the size of the The most likely explanation is that active Nevertheless, larger, randomized, prospec-
left ventricle, the opening of the mitral thoracic decompression combined with si- tive studies to answer the question on
valve during cardiac release, and atrioven- multaneous abdominal compression in- whether phased thoracoabdominal com-
tricular regurgitation support the cardiac creased the filling of the cardiac chambers pression can achieve any real hemody-
pump theory. Porter et al. (36) performed and thus produced higher stroke volumes. namic improvement over conventional
transesophageal echocardiography on 17 However this remains a conjecture because cardiocerebral resuscitation (42) are inevi-
human cardiac arrest victims during chest we lack quantitative Doppler measurement table.
compressions and found that the mitral data for the aortic outflow tract. Limitations. The conclusions of our
valve closed during the compression phase A recent study of blood flow during study are somewhat weakened by the
in 12 patients, who also had peak transmi- cardiopulmonary resuscitation (28) facts that the control groups were not
tral flow in the release phase of the chest claims that both mechanisms might be randomized, the physicians were not
compression cycles. Redberg et al. (34) involved in the generation of blood flow. blinded to the respective interventions,
found closed mitral valves in all 20 patients The transmitral flow pattern observed in and the relatively small sample size. Also,
during cardiopulmonary resuscitation in- all our patients during Lifestick resusci- informed consent was waived, and appro-
cluded in their study. In the current study, tation, independent of the position of the priately so, according to the Declaration
two out of five patients had open mitral mitral valve, can be interpreted to be of Helsinki. Furthermore, we only in-
valves during the compression phase under caused by both blood flow mechanisms cluded patients after prolonged cardio-
mechanical chest compressions and three operating jointly. Initially, the cardiac pulmonary resuscitation; therefore, we
out of 11 patients under Lifestick resusci- pump starts blood flow, and as soon as do not know whether our conclusions
tation. The difference between our data and the intrathoracic pressure exceeds a cer- would also be valid for patients after
that of Redberg et al. (34) might be due to tain level, then the thoracic pump pro- short-term cardiopulmonary resuscita-
the brief time interval between the start of vides additional pressure. We can only tion. However, there is usually a marked
cardiopulmonary resuscitation and the surmise that this was the predominant deterioration in coronary perfusion pres-
start of echocardiography (ⱕ7 mins) in mechanism for blood flow in our patients sure and end-tidal CO2 pressure as the
their study, which was substantially longer with prolonged cardiac arrest. time of unsuccessful resuscitation in-
in our study (collapse to Lifestick resusci- Laboratory studies (39 – 41) evaluating creases. Therefore improvements with
tation: mean 52 mins [34 –78 mins]). One phased chest and abdominal compression– the Thumper device are beyond what is
of our patients (patient 6) changed from decompression have arrived at similar find- expected by a usual course.

1836 Crit Care Med 2008 Vol. 36, No. 6

CONCLUSION 13. Lurie KG, Lindo C, Chin J: CPR: The P stands during external chest compression and car-
for plumber’s helper. JAMA 1990; 264:1661 diac massage. Crit Care Med 1981; 9:
Despite the statistical limitations due 14. Cohen TJ, Tucker KJ, Lurie KG, et al: Active 789 –792
to the relatively small number of patients compression-decompression: A new method 28. Chandra NC, Tsitlik JE, Halperin HR, et al:
included in this study, it is reasonable to of cardiopulmonary resuscitation. Cardiopul- Observations of hemodynamics during hu-
conclude that the use of the Lifestick monary Resuscitation Working Group. JAMA man cardiopulmonary resuscitation. Crit
1992; 267:2916 –2923 Care Med 1990; 18:929 –934
device in resuscitations is both safe and
15. Sunde K, Wik L, Naess PA, et al: Effect of 29. Koetter KP, Maleck WH: Effectiveness of me-
beneficial. Laboratory studies support different compression– decompression cycles chanical versus manual chest compressions
our findings about the positive hemody- on haemodynamics during ACD-CPR in pigs. in out-of-hospital cardiac resuscitation. Am J
namic effects of the Lifestick. Clearly, fur- Resuscitation 1998; 36:123–131 Emerg Med 1999; 17:210
ther studies covering a larger number of 16. Callaham M: Active compression-decompres- 30. Sommers MS: Potential for injury: Trauma
patients will be needed to provide the sion cardiopulmonary resuscitation. N Engl after cardiopulmonary resuscitation. Heart
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conclusions. 17. Skogvoll E, Wik L: Active compression- 31. Nagel EL, Fine EG, Krischer JP, et al: Com-
decompression cardiopulmonary resuscita- plications of CPR. Crit Care Med 1981; 9:424
tion: A population-based, prospective ran- 32. Baubin M, Rabl W, Pfeiffer KP, et al: Chest
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