Perhaps the most acclaimed method of cardiopulmonary resuscitation is that of active compression and decompression using the equivalent of a sink plunger. The compression device consists of a manually operated plunger which is applied to the precordium with a suction cup. This allows for active compression and decompression of the chest (Fig 3). Decompression actively re-expands the chest wall. The greater chest expansion during the relaxation phase of chest compression should increase the range of intrathoracic pressures and thereby augment pressure gradients, accounting for increased venous and aortic blood flow. In an initial report of randomized studies of victims of in-hospital cardiac arrest, active compression-decompression significantly increased the success of both initial resuscitation and 24-h survival. However, a more comprehensive clinical trial failed to confirm improvement in outcome ( Schwab ei a/ 1995). Experimentally, the increases in coronary perfusion pressure produced by this method are quite moderate.
Except for a potentially greater incidence of injury to the skin, the complications of active compression-decompression are comparable with those of conventional precordial compression.
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