Active compression-decompression cardiopulmonary resuscitation in standing position over the patient: pros and cons of a new method.

Active compression-decompression cardiopulmonary resuscitation (ACD-CPR) has been introduced to improve outcome of CPR after cardiac arrest. Usually, ACD-CPR is performed with the rescuer kneeling beside the patient (ACD-B), but ACD-CPR with the rescuer in standing position (ACD-S) has been taught and applied in some centres in addition to conventional ACD-CPR (ACD-B). The aim of this randomised and cross-over study was to evaluate the new technique of ACD-S and to compare it with conventional ACD-B. Twelve professional rescuers (aged 30.8 +/- 7.9 years) applied both methods of ACD-CPR on a manikin. We obtained the following results. (1) Duration of CPR performance was comparable for ACD-S (13.2 +/- 7.1 min) and ACD-B (15.5 +/- 10.2 min, P = 0.48). (2) Pain in the upper extremity and pain in the vertebral column were the main reasons for break-off by the rescuers. Exhaustion was judged to be similar during ACD-S (5.3 +/- 2.3) and ACD-B (6.2 +/- 2.1; on a rating scale with 1 = no and 9 = complete exhaustion). (3) Oxygen consumption was significantly higher during ACD-S (P < 0.005), whereas heart rate and lactate levels did not differ. (4) Decompression forces were lower than compression forces. The averaged decompression forces in both methods were similar during the first 2 min and the last min. Compression forces decreased in ACD-S from 55.1 to 48.9 kp (P = 0.002) and in ACD-B from 52.8 to 47.0 kp (P = 0.069). We conclude that ACD-CPR in standing position can be considered equal to ACD-B in view of maximal duration of CPR, exhaustion of the rescuers and decompression forces. The decrease of compression forces in ACD-S and ACD-B as well as the difference between compression forces in ACD-S and ACD-B seem to be of no clinical relevance, and exhaustion was judged to be similar despite oxygen consumption being higher in ACD-S than in ACD-B.

Rescuer's work capacity and duration of cardiopulmonary resuscitation.

Specific training in the techniques of cardiopulmonary resuscitation (CPR) has been the major aim of CPR education for both health care professionals and lay people over the past few decades. We performed a randomized trial to evaluate individual physiological parameters of 12 professional rescuers influencing duration and quality of standard CPR and active compression-decompression CPR. CPR duration was assessed according to individual work capacity after grouping rescuers as untrained and trained individuals, according to their work capacity of up to and including 100% and over 100%. The average work capacity of all the rescuers was determined by incremental exercise testing, resulting in 110.0 +/- 26.5% compared with data for the normal population. With 29.3 +/- 12.8 min duration, standard CPR was significantly longer than active compression-decompression CPR with 15.5 +/- 10.2 min duration (P = 0.009). No changes in the forces of compression and decompression were measured during active compression-decompression CPR, thus demonstrating maintenance of constant CPR quality. Duration of resuscitation was influenced by the CPR method performed and by the individual work capacity (P = 0.004 and P = 0.027, respectively). We conclude that the duration of CPR depends both on the method applied and the rescuers' individual work capacity and recommend improvement of work capacity by aerobic training especially for professional rescuers.

[Guided training as a therapeutic measure in the treatment of hyper- and hypotension]. / Gezieltes Training als therapeutisches Mittel in der Behandlung der Hyper- und Hypotonie.

The high prevalence of hypertension and orthostatic hypotension is a challenge for both preventive and curative medicine. Physical exercise can be of great therapeutic value in these disturbances of blood pressure regulation. Endurance training has been shown to normalize resting and exercise blood pressure in young borderline hypertensives. Other beneficial effects include a decrease in myocardial oxygen consumption (tension-time index) and plasma adrenaline levels at rest and during exercise and an improvement in left ventricular compliance. This can bei achieved without the risks and expense of long-term drug therapy. When medication is needed for the therapy of hypertension, drug-induced changes in blood pressure reaction and circulatory responses to physical training have to be considered. We found that orthostatic hypotension in otherwise healthy people is often associated with poor general physical condition. In such cases endurance training combined with isometric exercise aimed at increasing leg muscle tone is advisable. However, exercise training as a therapeutic measure has to be prescribed in terms of dose (frequency and duration), intensity and type of exercise. This requires an understanding of exercise physiology, as well as the ability to make a rational selection and evaluation of patients using a graded exercise test.