Available via license: CC BY 4.0
Content may be subject to copyright.
Lietal. Scand J Trauma Resusc Emerg Med (2022) 30:49
https://doi.org/10.1186/s13049-022-01036-y
ORIGINAL RESEARCH
Evaluation ofabdominal compression–
decompression combined withchest
compression CPR performed byanew device: Is
theprognosis improved afterthis combination
CPR technique?
Haishan Li1,2*† , Chao Wang1†, Hongyuan Zhang1,2, Fang Cheng3, Shuang Zuo1,4, Liyou Xu1,4, Hui Chen1 and
Xiaodong Wang2
Abstract
Introduction: This study was designed to compare the outcomes of standard cardiopulmonary resuscitation (STD-
CPR) and combined chest compression and abdominal compression–decompression cardiopulmonary resuscitation
(CO-CPR) with a new device following out-of-hospital cardiac arrest (OHCA). Moreover, we investigated whether
patient prognosis improved with this combination treatment.
Methods: This trial was a single-centre, prospective, randomized trial, and a blinded assessment of the outcomes
was performed. A total of 297 consecutive patients with OHCA were initially screened, and 278 were randomized to
the STD-CPR group (n = 135) or the CO-CPR group (n = 143). We compared the proportions of patients who achieved
a return of spontaneous circulation (ROSC), survived to hospital admission and survived to hospital discharge. In addi-
tion, we also performed the Kaplan–Meier analysis with a log-rank test at the end of the follow-up period to compare
the survival curves of the two groups.
Results: The differences were not statistically significant in the proportion of patients who achieved ROSC [31/135
(23.0%) versus 35/143 (24.5%)] and survived to hospital admission [28/135 (20.7%) versus 33/143 (23.1%)] between
the CO-CPR group and STD-CPR group. However, there was a significant difference in the proportion of patients who
survived to hospital discharge [16/135 (11.9%) versus 7/143 (4.9%)] between the two groups. Nine patients (6.7%)
in the CO-CPR group and 2 patients (1.4%) in the STD group showed good neurological outcomes according to
the cerebral performance category (CPC) scale score, and the difference was statistically significant (P = 0.003). The
Kaplan–Meier curves showed that the patients in the CO-CPR group achieved better survival benefits than those in
the STD-CPR group at the end of the follow-up period (log-rank P = 0.007).
© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the
original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or
other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line
to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory
regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this
licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco
mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Open Access
†Haishan Li and Chao Wang contributed equally to this work
*Correspondence: leehaishan@126.com
1 Department of Emergency, The Second People’s Hospital of Hefei, The
Affiliated Hefei Hospital of Anhui Medical University, Hefei, China
Full list of author information is available at the end of the article
Page 2 of 8
Lietal. Scand J Trauma Resusc Emerg Med (2022) 30:49
Background
Cardiac arrest is a severe, life-threatening condition
and remains a leading cause of out-of-hospital death
worldwide. Adult patients who experience out-of-hos-
pital cardiac arrest (OHCA) have a low survival rate,
approximately 10.4%, and only 8.2% of them survive
and have a good functional status [1]. Standard car-
diopulmonary resuscitation (STD-CPR), consisting of
chest compression and artificial ventilation, is consid-
ered the standard treatment for OHCA [1–3]. Con-
ventional chest compression does not always lead to a
perfusion pressure that is sufficient to maintain vital
organ blood flow and does not always fully restore
cardiac and brain function [4–7]. For years, clinicians
have pondered how to increase or maintain vital organ
blood flow during CPR.
Abdominal compression–decompression cardio-
pulmonary resuscitation could augment blood return
and cardiac output by increasing or reducing the
patient’s abdominal pressure. This method not only
achieves the conventional effect but can also be used
for patients with chest compression contraindications
such as chest wall deformity, rib fracture, or haemo-
pneumothorax. Several studies have shown that the
abdominal compression–decompression technique is
associated with increased coronary perfusion pressure
and cerebral blood flow, which can lead to improved
survival [8–11]. However, this technique has been
evaluated only with animal studies and case reports.
In addition, this method is mainly performed manually
and lacks any objective and visual parameters, such as
the force or depth of the compression–decompression;
it can also be difficult to accurately perform this tech-
nique. An abdominal CPR compression–decompres-
sion instrument, as an external and easy-to-use device,
has the potential to be useful in out-of-hospital emer-
gency medical services [11, 12]. The aim of this rand-
omized controlled trial was to determine whether the
combined use of conventional chest compression and
abdominal compression–decompression techniques
improved outcomes in out-of-hospital cardiac arrest
patients.
Materials andmethods
Study design
is study was conducted at the Hefei Second People’s
Hospital, Hefei, China, between 1 January 2020, and
31 December 2020. Hefei Second People’s Hospital, a
national CPR training centre in China, is a large refer-
ral hospital and a tertiary A-level hospital that has 2583
inpatient beds and over 2 million annual emergency and
outpatient visits. Our hospital health service manages
out-of-hospital health emergencies in Hefei city and res-
cues more than 350 patients who experience OCHA each
year. Our CPR team consists of two systems. e first
system, which performed STD-CPR or CO-CPR out of
the hospital, consists of six emergency rescue stations.
Each team in the station consists of two junior emer-
gency physicians, one paramedic, and one ambulance
driver. e second system, which performed advanced
life support, consists of one senior emergency physician,
six junior emergency physicians, a head nurse, and sev-
eral registered nurses from the emergency intensive care
unit (EICU). All members were trained to perform two
CPR methods according to the American Heart Asso-
ciation guidelines. Abdominal compression–decompres-
sion training was performed under the supervision of the
manufacturer’s monitoring staff.
e trial was retrospectively registered in the Chi-
nese Clinical Trial Registry (registered number:
ChiCTR2100049581). e study was approved by the
Ethics Committee of the Second People’s Hospital of
Hefei (e Affiliated Hefei Hospital of Anhui Medical
University, approval number 2020-Science-025), and the
requirement for informed consent was waived. is trial
is a single-centre, prospective, randomized trial in which
chest compression CPR after OHCA will be compared
with a method that combines chest compression and
abdominal compression–decompression CPR.
Patients
e inclusion criterion was OHCA in patients at least
18years of age. e exclusion criteria were patients aged
80years or older or patients with any contraindications
Conclusion: CO-CPR was more beneficial than STD-CPR in terms of survival benefits in patients who have suffered
out-of-hospital cardiac arrest.
Trial registration Chinese Clinical Trial Registry, registered number: ChiCT R2100 049581. Registered 30 July 2021- Retro-
spectively registered. http:// www. medre sman. org. cn/ uc/ index. aspx.
Keywords: Out-of-hospital cardiac arrest, Resuscitation, Chest compression, Abdominal compression–
decompression, Prognosis
Page 3 of 8
Lietal. Scand J Trauma Resusc Emerg Med (2022) 30:49
for the abdominal compression–decompression tech-
nique, including pregnancy, history of recent thoracic or
abdominal trauma/surgery, known terminal or end-stage
disease, or severe neurologic impairment.
Randomization andblinding
Randomization was performed by a statistics profes-
sional from our hospital. A random number table was
generated using SPSS 18.0 software. Numbers from the
table were assigned on a unified basis by the professional.
A blinded assessor evaluated the patient’s neurological
prognosis. e outcome assessors and trial statisticians
were also blinded. e clinical team responsible for the
participants (physicians, nurses, and others) and involved
with direct patient care were not blinded to the alloca-
tion group due to the inherent difficulty in blinding the
intervention.
Data collection andfollow‑up
Data were recorded following Utstein resuscitation
registry templates, including baseline characteristics,
witnesses, bystander CPR, first monitored rhythm, epi-
nephrine use, aetiology, event location and comorbidities.
All patients who were included in this study had a pri-
mary cardiac arrest, but cardiac arrests that occur out-
side the hospital are not always witnessed immediately.
erefore, the exact time from cardiac arrest to the ini-
tiation of CPR may not have been accurately determined
in all patients in our study; therefore, the no-flow time
was waived. Patients were followed-up by three methods:
outpatient visits, inpatient visits, or telephone calls. e
patients were followed up by a blinded assessor every 1 to
3months after discharge from the hospital, and the end-
point of the follow-up was the date of death or July 30,
2021.
Outcome measures
e primary outcome measure was the return of spon-
taneous circulation (ROSC). Secondary outcome meas-
ures were survival to hospital admission, survival to
hospital discharge, and neurological outcomes at hospital
discharge.
Neurological outcomes were assessed by the Cerebral
Performance Category (CPC) scale. e CPC scale cat-
egorizes neurological outcomes as follows: CPC 1, good
performance; CPC 2, moderate disability; CPC 3, severe
disability; CPC 4, comatose or persistent vegetative sta-
tus; and CPC 5, brain death or patient death [13]. e
prognosis in the two groups was compared by classifying
the CPC 1 or 2 patients as having a good neurological
outcome and those patients with a CPC ≥ 3 as having a
poor neurological outcome.
Sample size
We referred to another similar study at the time of the
sample size estimation for this study [12]. e study had
80% power to find a significant result with a threshold
two-sided p value of 0.05 if the expected proportion of
ROSC was approximately 20%. e sample size was re-
estimated as 122 patients for each group, and the final
sample size was increased to approximately 150 patients
due to a dropout rate of 20% (for details, see the supple-
mentary materials).
Instrument andintervention
Abdominal CPR compression–decompression instrument
e instrument, produced by Beijing Germari Medical
Equipment Co., Ltd., consisted of three components: a
display panel, pressure application handles, and a nega-
tive pressure device. A compression plate on the bottom
of the negative pressure device had to be placed on the
epigastrium. After turning on the device, negative pres-
sure was generated, which caused a tight bond between
these compression plates and the patient’s abdomen.
When we performed compression, the compression
force was approximately 186mmHg when the indicator
light was on. While decompression was performed, the
decompression force was approximately 112mmHg.
e operating parameters were as follows: (1) e
abdominal compression force was limited to 50kg, and
the decompression force was limited to 30kg; the force
levels were controlled from a light-emitting diode (LED)
display panel on top of the instrument. (2) e compres-
sion–decompression frequency was marked by an audio
signal with a frequency of 100times/min. Images of the
device are shown in Fig.1.
Interventions
In principle, CPR attempts were performed accord-
ing to current American Heart Association guidelines
[1]. Patients were randomized to receive either CO-
CPR or STD-CPR treatment. For CO-CPR, chest com-
pression was performed in alternation with abdominal
compression–decompression, i.e., when the chest was
compressed, the abdomen simultaneously would be
decompressed, and vice versa. Abdominal compression
was performed at a rate of 100 times/min and a depth of
5–10 cm. e rate of abdominal compression–decom-
pression cycles to chest compression cycles, marked by
the audio signal and delivered in alternation, was set to
Page 4 of 8
Lietal. Scand J Trauma Resusc Emerg Med (2022) 30:49
1:1. e effectiveness, safety, and stability of the abdomi-
nal compression–decompression device used in this
study have been verified in human studies [11, 12].
All methods were performed following relevant regu-
lations and guidelines. Defibrillation was administered
as needed. All patients were ventilated with a bag-valve
mask during resuscitation during the out-of-hospital
period. After referral to the hospital, all patients received
orotracheal intubation and respiration with the aid of a
rebreathing bag. Targeted temperature management with
a target temperature of 33 °C was performed in each
patient. e two CPR methods were applied until either
ROSC or resuscitation was deemed futile by the treating
emergency physicians.
Statistical analysis
PASS 15 software was used to calculate the sample size
(NCSS, LLC., Kaysville, Utah, USA). Statistical analysis
was performed using SPSS version 18.0 (SPSS Inc., Chi-
cago, IL, USA) and GraphPad Prism 8.0 (GraphPad Soft-
ware, La Jolla, California, USA). e continuous variables
are presented as the mean ± standard deviation (SD) and
were analysed by the independent samples t test, while
primary and secondary outcome analyses were con-
ducted using Fisher’s exact or Pearson chi-square (
x2
)
tests for comparison. Kaplan–Meier analysis with the
log-rank test was plotted to compare the survival curves
of the two groups at the end of the follow-up. A p value
less than 0.05 was considered statistically significant.
Results
Patients
A total of 297 consecutive patients with OHCA were
initially screened, and 278 were randomized to the STD-
CPR group (n = 135) or the CO-CPR group (n = 143).
e patient selection and reasons for exclusion are shown
in Fig.2. e patients’ baseline characteristics were simi-
lar in the two groups (Table1).
Primary outcome
In the primary analysis, 31 (23.0%) patients in the CO-
CPR group and 35 (24.5%) patients in the STD-CPR
group achieved ROSC (P = 0.767).
Fig. 1 The abdominal compression–decompression device and its use. A, B The abdominal compression–decompression device. C The training of
emergency physicians. D The performance of CO-CPR
Page 5 of 8
Lietal. Scand J Trauma Resusc Emerg Med (2022) 30:49
Secondary outcomes andfollow‑up
We also compared the survival to hospital admission
proportions, survival to hospital discharge propor-
tions, and neurological outcomes at hospital discharge
in the two groups. Twenty-eight patients (20.7%) in the
CO-CPR group and 33 patients (23.0%) in the STD-CPR
group survived to hospital admission (P = 0.638). How-
ever, there was a significant difference in the survival to
hospital discharge proportions [16/135 (11.9%) vs. 7/143
(4.9%)] between the two groups. Nine patients (6.7%) in
the CO-CPR group and 2 patients (1.4%) in the STD-CPR
group achieved good neurological outcomes according to
their CPC status (P = 0.003).
e follow-up evaluations were performed via outpa-
tient visits for 3 patients, inpatient visits for 8 patients,
and telephone calls for 23 patients. e follow-up time
ranged from 1 to 529 days, and the average follow-up
time was 61.7 ± 121.0 days. e Kaplan–Meier curves
showed a survival benefit favouring the CO-CPR group
when compared to the STD-CPR group at the end of the
follow-up period (log-rank P = 0.007, Fig.3).
Discussion
In the present study, we aimed to investigate the ben-
efit of combining conventional chest compression and
abdominal compression–decompression CPR for adult
OHCA patients. We found that higher proportions of
patients receiving the combination method with CO-
CPR had survived to hospital discharge, had better neu-
rological outcomes at discharge according to their CPC
status, and showed significant survival benefits when
compared with those receiving STD-CPR.
When cardiac arrest occurs, conventional chest com-
pression may enhance blood flow to provide sufficient
oxygen to vital organs. Various methods, such as the
external cardiac compressor Zoll Autopulse and LUCAS
mechanical chest compression system, have been applied
to improve efficiency and success rates. Unfortunately,
several studies found that mechanical chest compression
does not seem to improve outcomes after OHCA when
compared with manual chest compression [14–16]. In
addition, chest compression cannot be effectively applied
under some circumstances, such as in patients with chest
wall deformities, rib fractures, or haemopneumothorax.
Abdominal compression–decompression CPR was
invented as an alternative compression method to aug-
ment blood return and cardiac output. Abdominal com-
pression–decompression can change the amplitude
of diaphragm motion, which plays a role in the cardiac
pump, thoracic pump, and lung pump and enhances
blood flow to provide sufficient oxygen to vital organs.
is new method could help build circulatory and res-
piratory support and be used in cardiac arrest patients
with sternum and thoracic rib fractures. However, little is
known about whether patients with OHCA could benefit
from combined chest compression with abdominal com-
pression–decompression during CPR.
In most cases of primary cardiopulmonary arrest, blood
still contains some oxygen during the early period. Con-
ventional chest compression CPR is based on using a
Fig. 2 Flowchart for patient selection
Page 6 of 8
Lietal. Scand J Trauma Resusc Emerg Med (2022) 30:49
"thoracic pump," which is accomplished by compressing
the mid-sternum, which increases the pressure inside the
thorax, and blood is pumped out of the heart to the periph-
eral tissues, including the brain [12, 17]. In comparison,
the abdominal compression–decompression technique is
based on an "abdominal pump" model, which induces pres-
sure changes within the abdominal cavity and promotes the
return of blood from the abdominal cavity to fill the heart
and be eventually pumped to the brain [18, 19]. A combina-
tion of abdominal compression–decompression and chest
compression was previously shown to increase the venous
refilling of the heart, which could generate increased coro-
nary perfusion pressure and increase blood flow to vital
organs [9, 10, 20]. With this combination method, chest
release during abdominal compression leads to increased
venous return to the thorax by negative intrathoracic
Table 1 Demographic characteristics of the STD-CPR and CO-CPR groups
COPD, Chronic obstructive pulmonary disease
*Fisher’s exact or Pearson’s chi-square tests
a Epinephrine dose dichotomized according to median
CO‑CPR STD‑CPR P value*
Total (n = 135) Total (n = 143)
Baseline characteristics
Age(Mean ± SD), years 58.33 ± 14.88 59.62 ± 14.91 0.471
Men, n(%) 100(74.1%) 101(70.6%) 0.521
Witnessed, n(%) 81(60.0%) 84(58.7%) 0.831
Bystander CPR, n (%) 51(37.8%) 50(35.0%) 0.626
First monitored shockable rhythm, n (%) 11(8.1%) 17(11.9%) 0.300
Epinephrine < 5 mg, n(%)a30(22.2%) 39(27.3%) 0.330
Etiology
Medical, n (%) 110(81.5%) 108(75.5%) 0.228
Asphyxia, n (%) 14(10.4%) 12(8.4%) 0.571
Drowning, n (%) 0 2(1.4%) 0.499
Others, n (%) 11(8.1%) 21(14.7%) 0.088
Location
Home, n (%) 85(63.0%) 99(69.2%) 0.270
Public place, n (%) 23(17.0%) 18(12.6%) 0.296
Others, n (%) 27(20.0%) 26(18.2%) 0.700
Comorbidities
Diabetes, n (%) 48(35.6%) 50(35.0%) 0.918
Hypertension, n (%) 64(47.4%) 63(44.1%) 0.575
Malignancy, n (%) 14(10.4%) 13(9.1%) 0.719
Lung disease, n (%) 7(5.2%) 10(7.0%) 0.530
Previous stroke, n (%) 17(12.6%) 25(17.5%) 0.255
Chronic renal disease, n (%) 8(5.9%) 12(8.4%) 0.427
Cardiovascular disease, n (%) 77(57.0%) 69(48.3%) 0.143
COPD, n(%) 3(2.2%) 4(2.8%) 0.760
Fig. 3 Kaplan–Meier plot of the survival curves in the CO-CPR group
and the STD-CPR group at the end of follow-up
Page 7 of 8
Lietal. Scand J Trauma Resusc Emerg Med (2022) 30:49
pressure. Moreover, abdominal decompression during
chest compression may lead to increased blood flow via
decreased afterload. In myocardial blood flow, a better 48-h
outcome was documented with the combination method
compared with STD-CPR [21–24]. Hans-Richard Arntz
etal. reported that the Lifestick device could perform both
abdominal compression–decompression and chest com-
pression, improve the results of CPR, and reduce the rate
of injury compared to conventional resuscitation [10]. is
finding suggests that patients may benefit from the combi-
nation of both chest compression and abdominal compres-
sion–decompression techniques. However, studies that
compare the results and the use of different devices from
different institutions might have heterogeneous results,
and the results of these types of studies might have limited
applicability. In our study, the combination of the two CPR
methods improved the survival proportions and neurologi-
cal outcomes at discharge, and there was a survival benefit
at follow-up, which confirmed Hans-Richard Arntz etal.’s
observations. However, the device in our study was smaller
in volume, more straightforward in operation, and more
accurate in terms of the operating parameters.
A significant advantage in using the new device for
the combination of conventional chest compression and
abdominal compression–decompression was that the
instrument is small, lightweight, and easy to operate and
could be suitable for hospital and nonhospital use in a
variety of settings, including medical, sanitation, ambu-
lance, rescue, and health care institutions at all levels
inside and outside of the hospital.
is study has several limitations. e study was per-
formed at a single centre. Another limitation of the study
may be the relatively small number of subjects. Due to the
limited sample size, most cases of cardiac arrest occurred
in older patients. Autopsies were not performed in nonsur-
vivors; therefore, we were unable to determine whether the
abdominal compression–decompression technique resulted
in abdominal injuries in this study. e CO-CPR method
requires an additional rescuer and STD-CPR does not.
Conclusion
In summary, we conclude from our results that patients
could benefit from the combination of conventional
abdominal compression–decompression and chest com-
pression. Clearly, a large-scale clinical trial should be per-
formed with this promising new technique to obtain a
more comprehensive evaluation of its use.
Abbreviations
CPR: Cardiopulmonary resuscitation; STD-CPR: Standard (or chest com-
pression) cardiopulmonary resuscitation; CO-CPR: Combination of chest
compression and abdominal compression–decompression cardiopulmonary
resuscitation; OHCA: Out-of-hospital cardiac arrest; ROSC: Return of spontane-
ous circulation; AHA: American Heart Association; LED: Light-emitting diode;
CPC: Cerebral performance category; SD: Standard deviation; COPD: Chronic
obstructive pulmonary disease.
Supplementary Information
The online version contains supplementary material available at https:// doi.
org/ 10. 1186/ s13049- 022- 01036-y.
Additional le1.Sample Size Calculation in Detail.
Acknowledgements
Not applicable.
Author contributions
HL: Conceptualization, methodology, funding acquisition. CW: writing, original
draft and editing. HZ: validation, formal analysis, resources. FC: supervision,
data curation. SZ: blinding and allocation. LX: software. HC and XW were
equally contributing in investigation. And all authors reviewed the manuscript.
All authors read and approved the final manuscript.
Funding
This work was supported by the Applied Medicine Program Foundation of
Hefei Science Center, Chinese Academy of Sciences (No. Hwk2021yb011)
and the Science and Technology Program of Anhui Medical University (No.
2020xkj251).
Availability of data and materials
All study data are available upon reasonable request from the corresponding
author and may be reused as required (We also uploaded main part of data
in network of Clinical Trial Management Public Platform, http:// www. medre
sman. org. cn).
Declarations
Ethics approval and consent to participate
Institutional Review Board approval was obtained from the ethics committee
of the Second People’s Hospital of Hefei (approval number: 2020-Science-025).
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Author details
1 Department of Emergency, The Second People’s Hospital of Hefei, The
Affiliated Hefei Hospital of Anhui Medical University, Hefei, China. 2 Center
of 120 Emergency, Hefei, China. 3 Department of Nursing, The Second People’s
Hospital of Hefei, Hefei, China. 4 Department of Emergency Intensive Care Unit,
The Second People’s Hospital of Hefei, Hefei, China.
Received: 28 January 2022 Accepted: 2 August 2022
References
1. Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG,
Magid DJ, et al. Part 3: adult basic and advanced life support: 2020 Ameri-
can Heart Association Guidelines for cardiopulmonary resuscitation and
emergency cardiovascular care. Circulation. 2020;2020(142):S366–468.
2. Kamikura T, Iwasaki H, Myojo Y, Sakagami S, Takei Y, Inaba H. Advantage
of CPR-first over call-first actions for out-of-hospital cardiac arrests
in nonelderly patients and of noncardiac aetiology. Resuscitation.
2015;96:37–45.
Page 8 of 8
Lietal. Scand J Trauma Resusc Emerg Med (2022) 30:49
•
fast, convenient online submission
•
thorough peer review by experienced researchers in your field
•
rapid publication on acceptance
•
support for research data, including large and complex data types
•
gold Open Access which fosters wider collaboration and increased citations
maximum visibility for your research: over 100M website views per year
•
At BMC, research is always in progress.
Learn more biomedcentral.com/submissions
Ready to submit your research
Ready to submit your research
? Choose BMC and benefit from:
? Choose BMC and benefit from:
3. Iwami T, Kitamura T, Kiyohara K, Kawamura T. Dissemination of chest
compression-only cardiopulmonary resuscitation and survival after out-
of-hospital cardiac arrest. Circulation. 2015;132(5):415–22.
4. Lurie KG, Nemergut EC, Yannopoulos D, Sweeney M. The physiology of
cardiopulmonary resuscitation. Anesth Analg. 2016;122(3):767–83.
5. Paradis NA, Martin GB, Rivers EP, Goetting MG, Appleton TJ, Feingold
M, Nowak RM. Coronary perfusion pressure and the return of spon-
taneous circulation in human cardiopulmonary resuscitation. JAMA.
1990;263(8):1106–13.
6. Andreka P, Frenneaux MP. Haemodynamics of cardiac arrest and resusci-
tation. Curr Opin Crit Care. 2006;12(3):198–203.
7. Aufderheide TP, Frascone RJ, Wayne MA, Mahoney BD, Swor RA, Domeier
RM, Lurie KG, et al. Standard cardiopulmonary resuscitation versus active
compression–decompression cardiopulmonary resuscitation with aug-
mentation of negative intrathoracic pressure for out-of-hospital cardiac
arrest: a randomised trial. Lancet. 2011;377(9762):301–11.
8. Cohen TJ, Tucker KJ, Lurie KG, Redberg RF, Dutton JP, Dwyer KA, et al.
Active compression–decompression: a new method of cardiopulmonary
resuscitation—cardiopulmonary resuscitation working group. JAMA.
1992;267(21):2916–23.
9. Plaisance P, Lurie KG, Vicaut E, Adnet F, Petit JL, Epain D, Payen D, et al.
A comparison of standard cardiopulmonary resuscitation and active
compression–decompression resuscitation for out-of-hospital cardiac
arrest—French active compression–decompression cardiopulmonary
resuscitation study group. N Engl J Med. 1999;341(8):569–75.
10. Arntz HR, Agrawal R, Richter H, Schmidt S, Rescheleit T, Menges M,
Schultheiss HP, et al. Phased chest and abdominal compression–decom-
pression versus conventional cardiopulmonary resuscitation in out-of-
hospital cardiac arrest. Circulation. 2001;104(7):768–72.
11. Li M, Song W, Ouyang YH, Wu DH, Zhang J, Wang LX, Li J. Clinical evalu-
ation of active abdominal lifting and compression CPR in patients with
cardiac arrest. Am J Emerg Med. 2017;35(12):1892–4.
12. Zhang S, Liu Q, Han S, Zhang Z, Zhang Y, Liu Y, Wang L, et al. Standard
versus abdominal lifting and compression CPR. Evid Based Complem
Alternat Med. 2016;2016:9416908.
13. Jennett B, Bond M. Assessment of outcome after severe brain damage.
Lancet. 1975;1(7905):480–4.
14. Zeiner S, Sulzgruber P, Datler P, Keferböck M, Poppe M, Lobmeyr E, Sterz F,
et al. Mechanical chest compression does not seem to improve outcome
after out-of hospital cardiac arrest. A single center observational trial.
Resuscitation. 2015;96:220–5.
15. Rubertsson S, Lindgren E, Smekal D, Östlund O, Silfverstolpe J, Lichtveld
RA, Karlsten R, et al. Mechanical chest compressions and simultaneous
defibrillation vs conventional cardiopulmonary resuscitation in out-of-
hospital cardiac arrest. JAMA. 2014;311(1):53.
16. Panchal AR, Bartos JA, Cabanas JG, Donnino MW, Drennan IR, Hirsch KG,
Berg KM, et al. Part 3: adult basic and advanced life support: 2020 Ameri-
can Heart Association Guidelines for cardiopulmonary resuscitation and
emergency cardiovascular care. Circulation. 2020;142:S366-468.
17. Criley JM, Blaufuss AH, Kissel GL. Cough-induced cardiac compres-
sion self-administered from of cardiopulmonary resuscitation. JAMA.
1976;236(11):1246–50.
18. Babbs CF. Interposed abdominal compression CPR: a comprehensive
evidence based review. Resuscitation. 2003;59(1):71–82.
19. Aliverti A, Bovio D, Fullin I, Dellaca RL, Lo MA, Pedotti A, Macklem PT. The
abdominal circulatory pump. Plos One. 2009;4(5):e5550.
20. Wang CH, Tsai MS, Chang WT, Huang CH, Ma MH, Chen WJ, Lee CC,
et al. Active compression–decompression resuscitation and imped-
ance threshold device for out-of-hospital cardiac arrest: a systematic
review and metaanalysis of randomized controlled trials. Crit Care Med.
2015;43(4):889–96.
21. Beyar R, Kimmel E, Sideman S, Dinnar U, Kishon Y. Effect of thoracic and
abdominal pressure waves on blood flow in cardiopulmonary resuscita-
tion. Int J Heat Mass Trans. 1984;27(9):1473–83.
22. Wenzel V, Lindner KH, Prengel AW, Strohmenger HU. Effect of phased
chest and abdominal compression–decompression cardiopulmonary
resuscitation on myocardial and cerebral blood flow in pigs. Crit Care
Med. 2000;28(4):1107–12.
23. Babbs CF. CPR techniques that combine chest and abdominal compres-
sion and decompression: hemodynamic insights from a spreadsheet
model. Circulation. 1999;100(21):2146–52.
24. Geddes LA, Rundell A, Lottes A, Kemeny A, Otlewski M. A new cardiopul-
monary resuscitation method using only rhythmic abdominal compres-
sion: a preliminary report. Am J Emerg Med. 2007;25(7):786–90.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in pub-
lished maps and institutional affiliations.
