Key messages

• Techniques of conventional precordial compression generate a cardiac output that is typically less than 25 per cent of normal.

• The alternative interventions may be classified as modifications of chest compression, intravascular techniques, and open-chest cardiac massage.

• There is no persuasive evidence that modifications of chest compression, including interposed abdominal compression, vest cardiopulmonary resuscitation, active compression-decompression, and phased chest and abdominal compression-decompression, have improved the outcome of cardiac arrest.

• Although technically more demanding, intravascular methods, including ascending aortic balloon occlusion and extracorporeal circulation, and open-chest cardiac massage are currently hemodynamically more effective interventions.

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