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Update on Cardiopulmonary Resuscitation. Randall Brockman M.D. Cardiologist/Electrophysiologist Medical Officer for FDA. Circ System Devices Advisory Panel Sept 2004. Several Goals. To address important issues in clinical trial design for new CPR devices

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update on cardiopulmonary resuscitation

Update on Cardiopulmonary Resuscitation

Randall Brockman M.D.


Medical Officer for FDA

Circ System Devices Advisory Panel

Sept 2004

several goals
Several Goals
  • To address important issues in clinical trial design for new CPR devices
  • To provide a clinical summary of the history of CPR and devices to assist with #1
chain of survival
Chain of Survival
  • Rapid Access
  • Cardiopulmonary resuscitation
  • Early Defibrillation
  • Advanced cardiopulmonary life support
the beginnings of cpr
The Beginnings of CPR
  • Resuscitation of arrest patients has been attempted for over a century
  • In the 1950’s, Safar et al and Elam et al “rediscovered” mouth to mouth
  • In 1960, Kouwenhoven described chest compression
  • These two techniques form the critical steps of modern CPR
in hospital cardiac arrest
In-hospital Cardiac Arrest
  • Essentially unchanged over the last three to four decades
  • Return of spontaneous circulation (ROSC) in about 30% of patients
  • Approximately 15% of patients are discharged neurologically intact
interposed abdominal counterpulsation 14
Interposed Abdominal Counterpulsation14


% occurrence



out of hospital arrest
Out-of-hospital Arrest
  • Hospital admission rates of 8-22%
  • Survival to discharge with intact neurologic function 1-8%
  • Largely unchanged despite multiple additions to the basic components of CPR
no long term benefit
No Long Term Benefit
  • High dose epinephrine
    • Short term improvement (ROSC, hospital admission) 17
    • No long term improvement (hospital discharge and neurologic function) 17,18,19
  • Vest CPR20
    • Trend towards increased rate of ROSC and 24 hour survival but no difference in rate of hospital discharge
  • Transcutaneous pacing21
    • No improvement in rates of hospital admission or discharge
active compression decompression
Active-Compression Decompression
  • Several studies found no improvement22,23
  • Another study24 comparing ACD-CPR to S-CPR found improvement in several endpoints



% occurrence


combination devices
Combination devices
  • Inspiratory impedance threshold devices combined with ACD-CPR26,27




% occurrence


  • Survival rates with intact neurologic function have changed little over the past 30-40 years
  • Choosing appropriate endpoints for clinical trials will be important to determine which devices will facilitate improvement in long-term outcomes
  • Fostering an environment to enhance clinical research in this field will be important