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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
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  • Published on:
    The “Do’s and Don’ts” of active compression decompression CPR with an accelerometer feedback device
    • Nicolas Segal, Emergency Physician Department of Emergency Medicine, University of New Mexico, Albuquerque, NM, USA
    • Other Contributors:
      • Mathew M Cherian, Emergency Physician

    We read with interest the recent article by Setala et al, where active compression decompression cardiopulmonary resuscitation (ACD-CPR) was compared with manual CPR. 1 In this study, to ensure continuous high-quality resuscitation, an audiovisual feedback defibrillator (Zoll X Series, Real CPR Help, ZOLL Medical Corporation, USA) was used. This is a key element for cardiac arrest studies. It is known that quality of CPR is an important modifier in cardiac arrest studies. 2 High-quality CPR is necessary to be able to compare and generalize the results. There is, however, a major methodologic flaw in the Setala et al study. None of the accelerometers used in feedback defibrillator are adapted to analyze ACD-CPR. The issue arises from the fact that the accelerometers are designed to measure only one distance from the chest resting point at the end of the passive decompression to the compression maximum depth. In the Setala et al study, there was no difference in distance between groups 76 (SD 1.3) mm versus 71 (SD1.0) mm. However, in ACD CPR, you need active compression (5 cm) combined with active decompression (3 cm or 15kg of pulling). Given the reported data, there are two distinct possibilities. The first is that Setala et al were able to perform active decompression (rising the chest higher than the chest resting point) but that their compressions were not adequately deep enough. As a result, ETCO2 would be lower compared to CPR with high-quality compression. The second...

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    Conflict of Interest:
    None declared.