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End-tidal carbon dioxide output in manual cardiopulmonary resuscitation versus active compression-decompression device during prehospital quality controlled resuscitation: a case series study
  1. Piritta Anniina Setälä1,2,
  2. Ilkka Tapani Virkkunen2,
  3. Antti Jaakko Kämäräinen1,
  4. Heini Sisko Annamari Huhtala3,
  5. Janne Severi Virta1,
  6. Arvi Mikael Yli-Hankala4,5,
  7. Sanna Elisa Hoppu1
  1. 1Emergency Medical Services, Tampere University Hospital, Tampere, Finland
  2. 2Research and Development Unit, FinnHEMS Ltd, Vantaa, Finland
  3. 3Faculty of Social Sciences, University of Tampere, Tampere, Finland
  4. 4Medical School, University of Tampere, Tampere, Finland
  5. 5Department of Anaesthesia, Tampere University Hospital, Tampere, Finland
  1. Correspondence to Dr Piritta Anniina Setälä, Emergency Medical Service, Tampere University Hospital, Tampere 33521, Finland; piritta.setala{at}


Background Active compression–decompression (ACD) devices have enhanced end-tidal carbon dioxide (ETCO2) output in experimental cardiopulmonary resuscitation (CPR) studies. However, the results in out-of-hospital cardiac arrest (OHCA) patients have shown inconsistent outcomes, and earlier studies lacked quality control of CPR attempts. We compared manual CPR with ACD-CPR by measuring ETCO2 output using an audiovisual feedback defibrillator to ensure continuous high quality resuscitation attempts.

Methods 10 witnessed OHCAs were resuscitated, rotating a 2 min cycle with manual CPR and a 2 min cycle of ACD-CPR. Patients were intubated and the ventilation rate was held constant during CPR. CPR quality parameters and ETCO2 values were collected continuously with the defibrillator. Differences in ETCO2 output between manual CPR and ACD-CPR were analysed using a linear mixed model where ETCO2 output produced by a summary of the 2 min cycles was included as the dependent variable, the patient as a random factor and method as a fixed effect. These comparisons were made within each OHCA case to minimise confounding factors between the cases.

Results Mean length of the CPR episodes was 37 (SD 8) min. Mean compression depth was 76 (SD 1.3) mm versus 71 (SD1.0) mm, and mean compression rate was 100 per min (SD 6.7) versus 105 per min (SD 4.9) between ACD-CPR and manual CPR, respectively. For ETCO2 output, the interaction between the method and the patient was significant (P<0.001). ETCO2 output was higher with manual CPR in 6 of the 10 cases.

Conclusions This study suggests that quality controlled ACD-CPR is not superior to quality controlled manual CPR when ETCO2 is used as a quantitative measure of CPR effectiveness.

Trial registration number NCT00951704; Results.

  • cardiac arrest
  • prehospital care

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  • Contributors All authors certify that they have participated sufficiently in the work, including participation in the concept, design, analysis, writing or revision of the manuscript. ITV, AJK and SEH planned the study design. All authors collected the patient data. PAS analysed and interpreted the patient data. PAS and HSAH performed the statistical tests. PAS was a major contributor towards writing the manuscript. AMY-H made revisions to the manuscript. All authors read and approved the final manuscript. Each author certifies that this material has not been submitted to or published in any other publication.

  • Funding This study was financially supported by the Competitive Research Funding of Tampere University Hospital (grant 9P009) and by a grant from FinnHEMS Research and Development Unit. The funding organisations had no involvement in the planning, execution, analysis or reporting of any part of the study.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethics committee date of approval 12 April 2013, ETL:R08116, from the regional ethics committee of Pirkanmaa Health District, Tampere University Hospital PO Box 2000, FI-33521 Tampere, Finland.

  • Provenance and peer review Not commissioned; externally peer reviewed.