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BMJ 2011; 342 doi: (Published 24 January 2011) Cite this as: BMJ 2011;342:d429

Augmented CPR improves survival after cardiac arrest outside hospital

Measures to improve the efficiency of cardiopulmonary resuscitation include a suction cup attached to the patient’s chest that enables the rescuer to pull up as well as push down, and an impedance valve placed between the bag and mask (or advanced airway) to limit passive entry of air during chest recoil and keep intrathoracic pressure down. Both measures encourage venous return and boost blood flow to vital organs. But do they save lives?

Advanced Circulatory Systems

In a large trial from the US, use of both devices together significantly improved the odds of surviving an out of hospital cardiac arrest with no more than moderate disability (9% (75/840) v 6% (47/ 813); odds ratio 1.58, 95% CI 1.07 to 2.36). Controls had standard cardiopulmonary resuscitation. The survival benefits emerged at hospital discharge and lasted for at least one year, despite a significant excess of pulmonary oedema in patients resuscitated with the new devices (11% (94/840) v 7% (62/813); P=0.015).

One commentator (doi:10.1016/S0140-6736(10)62309-4) described these results as striking but warned professional bodies and rescue services to wait for independent confirmation before launching wholesale reform of CPR protocols. This trial was paid for by the manufacturer of both devices, and even they ran out of money before researchers could determine which device was responsible for improving survival. A third arm testing the impedance valve alone had to be abandoned because recruitment was so slow.

Researchers characterise risky coronary artery lesions using intraluminal ultrasound

Around a fifth (135/697) of a cohort of patients treated successfully for acute coronary syndrome had another event within three years. Worsening or unstable angina was the most common problem, although a minority (31/697) had a myocardial infarction, a cardiac arrest, or a cardiac death. An estimated 12.9% of the cohort had an event caused by their original coronary artery lesion. An estimated 11.6% had events caused by …

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