Abdominal compressions during cardiopulmonary resuscitation: a scoping review

Lima, Magda Mileyde de Sousa; Ximenes, Maria Aline Moreira; Araújo, Dariane Veríssimo de; Barros, Lívia Moreira; Galindo Neto, Nelson Miguel; Caetano, Joselany Áfio

doi:10.1590/0034-7167-2022-0400

Magda Mileyde de Sousa Lima

conception or design of the study/research

analysis and/or interpretation of data

final review with critical and intellectual participation in the manuscript

Universidade Federal do Ceará. Fortaleza, Ceará, Brazil

https://orcid.org/0000-0001-5763-8791

Maria Aline Moreira Ximenes

conception or design of the study/research

analysis and/or interpretation of data

final review with critical and intellectual participation in the manuscript

Universidade Federal do Ceará. Fortaleza, Ceará, Brazil

https://orcid.org/0000-0002-1674-3357

Dariane Veríssimo de Araújo Corresponding author: Dariane Veríssimo de Araújo, E-mail: dariane.verissimo@gmail.com

conception or design of the study/research

analysis and/or interpretation of data

final review with critical and intellectual participation in the manuscript

Universidade Federal do Ceará. Fortaleza, Ceará, Brazil

https://orcid.org/0000-0001-5459-9678

Lívia Moreira Barros

conception or design of the study/research

analysis and/or interpretation of data

final review with critical and intellectual participation in the manuscript

Universidade da Integração Internacional da Lusofonia, Afro-Brasileira. Redenção, Ceará, Brazil.

https://orcid.org/0000-0002-9763-280X

Nelson Miguel Galindo Neto

conception or design of the study/research

analysis and/or interpretation of data

final review with critical and intellectual participation in the manuscript

Instituto Federal de Educação, Ciência e Tecnologia de Pernambuco. Pernambuco, Ceará, Brazil.

https://orcid.org/0000-0002-7003-165X

Joselany Áfio Caetano

conception or design of the study/research

analysis and/or interpretation of data

final review with critical and intellectual participation in the manuscript

Universidade Federal do Ceará. Fortaleza, Ceará, Brazil

https://orcid.org/0000-0002-0807-056X

Corresponding author: Dariane Veríssimo de Araújo, E-mail: dariane.verissimo@gmail.com

EDITOR IN CHIEF: Álvaro Sousa

ASSOCIATE EDITOR: Anabela Coelho

Database

Search Strategy

Scopus, Pubmed/Medline, Pubmed/PMC, Web of Science, Cinahl, Scielo, Cochrane e Embase

(“heart arrest” OR “death, sudden, cardiac” OR “cardiac arrests” OR “cardiopulmonary arrest” OR “sudden death” OR “cardiopulmonary resuscitation” OR “basic life support” OR “advanced life support” OR “fist aid” OR “basic cardiac life support” OR “cpr” OR “cardio-pulmonary resuscitation” OR “life support, basic cardiac” OR “heart massage” ) AND (“abdominal compression” OR “abdominal compressions” OR “adbomen” OR “abdominal lifting” OR “abdominal compression decompression”)

Authors/Year	Country	Design/Number of patients	Eligibility criteria	Study limitations	Outcomes	Recommendation /Evidence level
Berryman CR & Phillips GM(¹¹11 Berryman CR, Phillips GM. Interposed abdominal compression-CPR in human subjects. Ann Emerg Med. 1984;13(4):226-9. https://doi.org/10.1016/s0196-0644(84)80467-9 https://doi.org/10.1016/s0196-0644(84)80... ) (1984)	United States	Prospective study with a case group / 06 patients.	Patients in non-traumatic cardiac arrest.	Not specified.	Increased systolic and mean blood pressure with the use of abdominal compression CPR compared to standard CPR.	C/4
McDonald JL(¹²12 McDonald JL. Effect of interposed abdominal compression during CPR on central arterial and venous pressures. Am J Emerg Med. 1985;3(2):156-9. https://doi.org/10.1016/0735-6757(85)90041-5 https://doi.org/10.1016/0735-6757(85)900... ) (1985)	United States	Prospective study with a case group / 06 patients.	Not specified	No verification of initial or mean diastolic pressure.	The technique of compressing the abdomen does not result in increased systolic blood pressures.	C/4
Mateer JR, Stueven HA, Thompson BM, et al (¹³13 Mateer JR, Stueven HA, Thompson BM, Aprahamian C, Darin JC. Pre-hospital IAC-CPR versus standard CPR: paramedic resuscitation of cardiac arrests. Am J Emerg Med. 1985;3(2):143-6. https://doi.org/10.1016/0735-6757(85)90038-5 https://doi.org/10.1016/0735-6757(85)900... ) (1985)	United States	Randomized prospective study with case and control groups / 291 adults: 146 patients had standard CPR, and 145 had CPR with interposed abdominal compression.	Excluded patients with cardiac arrest due to trauma and with a history of abdominal aortic aneurysm, age <12 years, suspected pregnancy, victims of poisoning, or if intravenous access was not obtained.	Not specified.	CPR with interposed abdominal compressions did not improve resuscitation rates.	A/1B
Howard M, Carrubba C, Foss F, et al(¹⁴14 Howard M, Carrubba C, Foss F, Janiak B, Hogan B, Guinness M. Interposed abdominal compression-CPR: Its effects on parameters of coronary perfusion in human subjects. Ann Emerg Med. 1987;16(3):253-9. https://doi.org/10.1016/s0196-0644(87)80169-5 https://doi.org/10.1016/s0196-0644(87)80... ) (1987)	United States	Prospective study with a case group / 14 adults with an average age of 56 years.	Included patients with pre-hospital cardiac arrest and excluded patients <16 years old, pregnant women, or with a history of aortic aneurysm, abdominal mass, hepato-splenomegaly, and cardiac arrest secondary to trauma.	Not specified.	The data indicate that it is unlikely to significantly improve survival rates in CPR with interposed abdominal compression.	B/2B
Ward KR, Sullivan RJ, Zelenak RR, et al(¹⁵15 Ward KR, Sullivan RJ, Zelenak RR, Summer WR. A comparison of interposed abdominal compression CPR and standard CPR by monitoring end-tidal PCO2. Ann Emerg Med. 1989;18(8):831-7. https://doi.org/10.1016/s0196-0644(89)80206-9 https://doi.org/10.1016/s0196-0644(89)80... ) (1989)	United States	Prospective and randomized study with case and control groups / 26 adults: 13 received standard CPR, and 13 had CPR with interposed abdominal compression.	Included patients with non-traumatic cardiac arrest and excluded those with a history of abdominal aortic aneurysm, coagulopathy, ascites, recent abdominal surgery, and pregnant women.	Low number of autopsies in non-surviving patients.	Cardiac output may be significantly increased during CPR with interposed abdominal compressions.	A/1B
Barranco F, Lesmes A, Irles JA, et al(¹⁶16 Barranco F, Lesmes A, Irles JA, Blasco J, Leal J, Rodriguez J, et al. Cardiopulmonary resuscitation with simultaneous chest and abdominal compression: comparative study in humans. Resusc. 1990;20(1):67-77. https://doi.org/10.1016/0300-9572(90)90088-v https://doi.org/10.1016/0300-9572(90)900... ) (1990)	Spain	Prospective study with a case group / 18 adults.	Included patients with brain death, post-anoxic encephalopathy with coma lasting more than 48 hours, and irreversible multiple organ failure.	Not specified.	The use of simultaneous chest and abdominal compressions produces higher intravascular pressure.	B/2B
Sack JB, Kesselbrenner MB & Jarrad A(¹⁷17 Sack JB, Kesselbrenner MB, Jarrad A. Interposed abdominal compression-cardiopulmonary resuscitation and resuscitation outcome during asystole and electromechanical dissociation. Circ. 1992;86(6):1692-700. https://doi.org/10.1161/01.cir.86.6.1692 https://doi.org/10.1161/01.cir.86.6.1692... ) (1992)	United States	Randomized prospective study with case and control groups / 143 adults.	Included adults in cardiac arrest aged >18 years and excluded patients with traumatic cardiac arrest and a history of aortic aneurysm, recent abdominal surgery, pregnancy, and patients with endotracheal intubation taking more than 5 minutes.	Absence of neurological evaluation in the first 24 hours, inability to blind the investigators during CPR, lack of tests identifying rib fractures incidence, and lack of standardization of compressions.	The addition of interposed abdominal compression can be a useful complement to standard CPR.	A/1B
Sack JB(¹⁸18 Sack JB. Survival from in-hospital cardiac arrest with interposed abdominal counterpulsation during cardiopulmonary resuscitation. JAMA. 1992;267(3):379. https://doi.org/10.1001/jama.1992.03480030057037 https://doi.org/10.1001/jama.1992.034800... ) (1992)	United States	Controlled and randomized trial with case and control groups / 103 adults: 55 received standard CPR, and 48 had CPR with interposed abdominal compression.	Included adults in cardiac arrest and excluded patients with a history of abdominal aortic aneurysm and suspected pregnancy.	Inability to blind the investor during the resuscitation process.	CPR with interposed abdominal compression may significantly improve survival after in-hospital cardiac arrest.	A/1B
Adams CP, Martin GB, Rivers EP, et al(¹⁹19 Adams CP, Martin GB, Rivers EP, Ward K, Smithline HA, Rady MY. Hemodynamics of interposed abdominal compression during human cardiopulmonary resuscitation. Acad Emerg Med. 1994;1(5):498-502. https://doi.org/10.1111/j.1553-2712.1994.tb02536.x https://doi.org/10.1111/j.1553-2712.1994... ) (1994)	United States	Prospective study with a case group / 20 adults.	Included normothermic adults with non-traumatic cardiac arrest in a pre-hospital setting. Patients with a history of abdominal aortic aneurysm, coagulopathy, ascites, recent thoracic or abdominal surgery, and pregnancy were excluded.	The patients received standard CPR followed by CPR with interposed abdominal compression; thus, the time may have been a bias for the abdominal CPR results. Additionally, another limitation was the non-administration of vasopressors.	CPR with interposed abdominal compression is an option during CPR as it does not require any special equipment.	B/2B
Villa GF, Colombo S, Cabrini L, et al(²⁰20 Villa GF, Colombo S, Cabrini L, Scandroglio AM, Torri G. Interposed abdominal compression in mechanical cardiopulmonary resuscitation: description of a clinical case. Minerva Anestesiol [Internet]. 1998[cited 2022 Aug 20];64(9):415-8. Available from: https://pubmed.ncbi.nlm.nih.gov/9835731/ https://pubmed.ncbi.nlm.nih.gov/9835731/... ) (1998)	Italy	Case study / A 54-year-old man.	Not applicable	Not applicable.	Return of spontaneous circulation.	C/4
Rottenberg EM, Heard J, Hamlin R, et al(²¹21 Rottenberg EM, Heard J, Hamlin R, Sun BC, Awad H. Abdominal only CPR during cardiac arrest for a patient with an LVAD during resternotomy: a case report. J Cardiothorac Surg. 2011;6(1):1-4. https://doi.org/10.1186/1749-80906-91 https://doi.org/10.1186/1749-80906-91... ) (2011)	United States	Case study / A 56-year-old man.	Not applicable	Not applicable.	Return of spontaneous circulation.	C/4
Li J, Wang J &Li T(²²22 Li J, Wang J, Li T. Interposed abdominal compression-cardiopulmonary resuscitation after cardiac surgery. Interact Cardiovasc Thorac Surg. 2014;19(6):985-9. https://doi.org/10.1093/icvts/ivu255 https://doi.org/10.1093/icvts/ivu255... ) (2014)	China	Prospective and observational study with case and control groups / 40 adults in cardiac arrest: 21 received standard CPR, and 19 had CPR with interposed abdominal compression.	Included patients in cardiac arrest outside the ICU and excluded arrests during the preoperative period or after the first 24 hours in the ICU.	Small size of study groups, all patients who suffered from cardiac arrest had little gastric juice in the stomach, and absence of autopsy in all non-survivors.	CPR with interposed abdominal compression after cardiac surgery is feasible and safe and may be advantageous in cardiac arrest.	B/3B
McClung C & Anshus A(²³23 McClung C, Anshus A. Interposed Abdominal Compression CPR for an Out-of Hospital Cardiac Arrest Victim Failing Traditional CPR. West J Emerg Med. 2015;16(5):690-2. https://doi.org/10.5811/westjem.2015.6.26082 https://doi.org/10.5811/westjem.2015.6.2... ) (2015)	United States	Case study / A 79-year-old woman.	Not applicable	Not applicable.	Return of spontaneous circulation.	C/4
Zhang S, Liu Q & Han S, et al(²⁴24 Zhang S, Liu Q, Han S, Zhang Z, Zhang Y, Liu Y, et al. Standard versus Abdominal Lifting and Compression CPR. J Evid Based Complementary Altern Med. 2016;1-8. https://doi.org/10.1155/2016/9416908 https://doi.org/10.1155/2016/9416908... ) (2016)	China	Prospective study with a case and control group / 83 adults in cardiac arrest: 43 received standard CPR, and 40 received elevation and abdominal compression CPR.	Included adults in cardiac arrest, weighing 40 to 150 kg, and excluded patients with do-not-resuscitate orders, abdominal injury, diaphragm rupture, abdominal aortic aneurysm, abdominal tumor, patients with debilitating chronic diseases, or severe tuberculosis.	Single-center study, small sample size, and absence of autopsies in non-surviving patients.	CPR with elevation and abdominal compression is associated with a higher survival rate than standard CPR.	B/3B
Movahedi A, Mirhafez SR & Behnam-Voshani H, et al(²2 Movahedi A, Mirhafez SR, Behnam-Voshani H, Reihani H, Kavosi A, Ferns GA, et al. A Comparison of the effect of interposed abdominal compression cardiopulmonary resuscitation and standard cardiopulmonary resuscitation methods on end-tidal CO2 and the return of spontaneous circulation following cardiac arrest: a clinical trial. Acad Emerg Med. 2016;23(4):448-54. https://doi.org/10.1111/acem.12903 https://doi.org/10.1111/acem.12903... ) (2016)	Iran	Randomized clinical trial with a case and control group / 80 adults.	Included adults in non-traumatic cardiac arrest, aged between 18 and 85 years, with a tracheal tube. Patients with a history of abdominal aortic aneurysm, coagulopathy, significant ascites, abdominal surgery within the last 2 weeks, active gastrointestinal bleeding, pulmonary embolism, and suspected pregnancy were excluded.	Time of cardiac arrest before CPR not estimated. Patients’ minute ventilation during CPR was not measured due to the use of bag-valve-mask device, lack of standardization of compressions, and absence of neurological evaluation within 24 hours.	CPR with interposed abdominal compression did not significantly increase the return of spontaneous circulation when compared to standard CPR.	A/1B
Li M, Song W & Ouyang Y, et al(²⁶26 Khanghah AG, Moghadamnia MT, Panahi L, Pouy S, Nargesi MA, Leyli EK. Effect of interposed abdominal compression on cardiopulmonary resuscitation outcomes: a randomized clinical trial. Archi Acad Emerg Med. 2022;10(1):e57-e57. https://doi.org/10.22037/aaem.v10i1.1678 https://doi.org/10.22037/aaem.v10i1.1678... ) (2017)	China	Prospective study with a case group / 35 adults.	Included adult patients in cardiac arrest; weight between 40 and 150 kg, and with inefficient chest compressions due to chest trauma, hemothorax, or pneumothorax. Patients with abdominal trauma, diaphragm rupture, abdominal hemorrhage, abdominal aortic aneurysm, pregnancy, intestinal obstruction, abdominal cancer, ascites, or ovarian cyst were excluded.	Single-center study, small sample size, absence of a control group, and analysis of secondary outcome only after 30 minutes of venous return.	CPR with abdominal compression and elevation may improve patient outcomes.	B/2B
Khanghah AG, et al(²⁷27 American Heart Association (USA). Guidelines for CPR and ECC [Internet]. 2020[cited 2022 Aug 20]. Available from: https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlghts_2020_ecc_guidelines_english.pdf https://cpr.heart.org/-/media/cpr-files/... ) (2022)	Iran	Randomized Clinical Trial / 90 adults (45 in each group).	Included patients with non-traumatic cardiac arrest. Patients with hepatic cirrhosis, abdominal surgery within the last two weeks, active gastrointestinal bleeding, a history of pulmonary embolism, abdominal aortic aneurysm, significant abdominal ascites, abdominal cirrhosis, and coagulation disorders were excluded.	Absence of neurological evaluation in surviving patients.	Abdominal compression during CPR may improve resuscitation outcomes in cardiac arrest patients.	A/1B

Management of CPR with Interposed Abdominal Compressions
Mechanism for performing abdominal compressions
Abdominal compressions are carried out using a mechanical device comprising three components: a display panel, pressure application handles, and a negative pressure device. Manual abdominal compressions.
Protocol 1: CPR with Elevation and Abdominal Compression
-Identification of cardiac arrest following the AHA protocol (unconscious victim, no pulse, no breathing, or agonal breathing). -Abdominal compressions are performed using the mechanical device. The depth, rate, and frequency of abdominal compressions adhere to the same guidelines as AHA-recommended chest compressions(²⁴24 Zhang S, Liu Q, Han S, Zhang Z, Zhang Y, Liu Y, et al. Standard versus Abdominal Lifting and Compression CPR. J Evid Based Complementary Altern Med. 2016;1-8. https://doi.org/10.1155/2016/9416908 https://doi.org/10.1155/2016/9416908... 25 Li M, Song W, Ouyang Y, Wu D, Zhang J, Wang L, Li J. Clinical evaluation of active abdominal lifting and compression CPR in patients with cardiac arrest. Am J Emerg Med. 2017;35(12):1892-4. https://doi.org/10.1016/j.ajem.2017.06.031 https://doi.org/10.1016/j.ajem.2017.06.0... -²⁶26 Khanghah AG, Moghadamnia MT, Panahi L, Pouy S, Nargesi MA, Leyli EK. Effect of interposed abdominal compression on cardiopulmonary resuscitation outcomes: a randomized clinical trial. Archi Acad Emerg Med. 2022;10(1):e57-e57. https://doi.org/10.22037/aaem.v10i1.1678 https://doi.org/10.22037/aaem.v10i1.1678... ). -Orotracheal intubation is conducted during advanced life support(²⁴24 Zhang S, Liu Q, Han S, Zhang Z, Zhang Y, Liu Y, et al. Standard versus Abdominal Lifting and Compression CPR. J Evid Based Complementary Altern Med. 2016;1-8. https://doi.org/10.1155/2016/9416908 https://doi.org/10.1155/2016/9416908... ). -The duration of compression and elevation is defined in a 1:1 ratio(²⁶26 Khanghah AG, Moghadamnia MT, Panahi L, Pouy S, Nargesi MA, Leyli EK. Effect of interposed abdominal compression on cardiopulmonary resuscitation outcomes: a randomized clinical trial. Archi Acad Emerg Med. 2022;10(1):e57-e57. https://doi.org/10.22037/aaem.v10i1.1678 https://doi.org/10.22037/aaem.v10i1.1678... ). -The applied compression force is approximately 186 mmHg, and the elevation force is approximately 112 mmHg(²2 Movahedi A, Mirhafez SR, Behnam-Voshani H, Reihani H, Kavosi A, Ferns GA, et al. A Comparison of the effect of interposed abdominal compression cardiopulmonary resuscitation and standard cardiopulmonary resuscitation methods on end-tidal CO2 and the return of spontaneous circulation following cardiac arrest: a clinical trial. Acad Emerg Med. 2016;23(4):448-54. https://doi.org/10.1111/acem.12903 https://doi.org/10.1111/acem.12903... ). -The compression-to-ventilation ratio is set at 30:2(²⁶26 Khanghah AG, Moghadamnia MT, Panahi L, Pouy S, Nargesi MA, Leyli EK. Effect of interposed abdominal compression on cardiopulmonary resuscitation outcomes: a randomized clinical trial. Archi Acad Emerg Med. 2022;10(1):e57-e57. https://doi.org/10.22037/aaem.v10i1.1678 https://doi.org/10.22037/aaem.v10i1.1678... ). -Medications are administered following the current AHA protocol at the time of the study(²⁴24 Zhang S, Liu Q, Han S, Zhang Z, Zhang Y, Liu Y, et al. Standard versus Abdominal Lifting and Compression CPR. J Evid Based Complementary Altern Med. 2016;1-8. https://doi.org/10.1155/2016/9416908 https://doi.org/10.1155/2016/9416908... ).
Protocol 2: CPR with Simultaneous Abdominal and Thoracic Compressions
-Identification of cardiac arrest following the AHA protocol (unresponsive victim, no pulse, no breathing, or gasping breathing). -The protocol was initiated 2 minutes after the cessation of aortic pressure(¹⁶16 Barranco F, Lesmes A, Irles JA, Blasco J, Leal J, Rodriguez J, et al. Cardiopulmonary resuscitation with simultaneous chest and abdominal compression: comparative study in humans. Resusc. 1990;20(1):67-77. https://doi.org/10.1016/0300-9572(90)90088-v https://doi.org/10.1016/0300-9572(90)900... ). -Simultaneous abdominal and thoracic compressions were performed(¹⁶16 Barranco F, Lesmes A, Irles JA, Blasco J, Leal J, Rodriguez J, et al. Cardiopulmonary resuscitation with simultaneous chest and abdominal compression: comparative study in humans. Resusc. 1990;20(1):67-77. https://doi.org/10.1016/0300-9572(90)90088-v https://doi.org/10.1016/0300-9572(90)900... ). -Thoracic compression was carried out using an external device with parameters in accordance with the AHA guidelines at the time. A slightly inflated blood pressure cuff was placed over the mesogastric area. A mercury column was attached to the cuff. The abdominal compressions had a pressure of 100 mmHg during the relaxation phase of the chest(¹⁶16 Barranco F, Lesmes A, Irles JA, Blasco J, Leal J, Rodriguez J, et al. Cardiopulmonary resuscitation with simultaneous chest and abdominal compression: comparative study in humans. Resusc. 1990;20(1):67-77. https://doi.org/10.1016/0300-9572(90)90088-v https://doi.org/10.1016/0300-9572(90)900... ).
Protocolo 3: CPR with Interposed Abdominal Compression
- Identification of cardiac arrest following the AHA protocol (unresponsive victim, no pulse, no breathing, or gasping breathing)(²2 Movahedi A, Mirhafez SR, Behnam-Voshani H, Reihani H, Kavosi A, Ferns GA, et al. A Comparison of the effect of interposed abdominal compression cardiopulmonary resuscitation and standard cardiopulmonary resuscitation methods on end-tidal CO2 and the return of spontaneous circulation following cardiac arrest: a clinical trial. Acad Emerg Med. 2016;23(4):448-54. https://doi.org/10.1111/acem.12903 https://doi.org/10.1111/acem.12903... ,¹¹11 Berryman CR, Phillips GM. Interposed abdominal compression-CPR in human subjects. Ann Emerg Med. 1984;13(4):226-9. https://doi.org/10.1016/s0196-0644(84)80467-9 https://doi.org/10.1016/s0196-0644(84)80... ,¹³13 Mateer JR, Stueven HA, Thompson BM, Aprahamian C, Darin JC. Pre-hospital IAC-CPR versus standard CPR: paramedic resuscitation of cardiac arrests. Am J Emerg Med. 1985;3(2):143-6. https://doi.org/10.1016/0735-6757(85)90038-5 https://doi.org/10.1016/0735-6757(85)900... 14 Howard M, Carrubba C, Foss F, Janiak B, Hogan B, Guinness M. Interposed abdominal compression-CPR: Its effects on parameters of coronary perfusion in human subjects. Ann Emerg Med. 1987;16(3):253-9. https://doi.org/10.1016/s0196-0644(87)80169-5 https://doi.org/10.1016/s0196-0644(87)80... -¹⁵15 Ward KR, Sullivan RJ, Zelenak RR, Summer WR. A comparison of interposed abdominal compression CPR and standard CPR by monitoring end-tidal PCO2. Ann Emerg Med. 1989;18(8):831-7. https://doi.org/10.1016/s0196-0644(89)80206-9 https://doi.org/10.1016/s0196-0644(89)80... ,¹⁷17 Sack JB, Kesselbrenner MB, Jarrad A. Interposed abdominal compression-cardiopulmonary resuscitation and resuscitation outcome during asystole and electromechanical dissociation. Circ. 1992;86(6):1692-700. https://doi.org/10.1161/01.cir.86.6.1692 https://doi.org/10.1161/01.cir.86.6.1692... 18 Sack JB. Survival from in-hospital cardiac arrest with interposed abdominal counterpulsation during cardiopulmonary resuscitation. JAMA. 1992;267(3):379. https://doi.org/10.1001/jama.1992.03480030057037 https://doi.org/10.1001/jama.1992.034800... 19 Adams CP, Martin GB, Rivers EP, Ward K, Smithline HA, Rady MY. Hemodynamics of interposed abdominal compression during human cardiopulmonary resuscitation. Acad Emerg Med. 1994;1(5):498-502. https://doi.org/10.1111/j.1553-2712.1994.tb02536.x https://doi.org/10.1111/j.1553-2712.1994... -²⁰20 Villa GF, Colombo S, Cabrini L, Scandroglio AM, Torri G. Interposed abdominal compression in mechanical cardiopulmonary resuscitation: description of a clinical case. Minerva Anestesiol [Internet]. 1998[cited 2022 Aug 20];64(9):415-8. Available from: https://pubmed.ncbi.nlm.nih.gov/9835731/ https://pubmed.ncbi.nlm.nih.gov/9835731/... ,²²22 Li J, Wang J, Li T. Interposed abdominal compression-cardiopulmonary resuscitation after cardiac surgery. Interact Cardiovasc Thorac Surg. 2014;19(6):985-9. https://doi.org/10.1093/icvts/ivu255 https://doi.org/10.1093/icvts/ivu255... -²³23 McClung C, Anshus A. Interposed Abdominal Compression CPR for an Out-of Hospital Cardiac Arrest Victim Failing Traditional CPR. West J Emerg Med. 2015;16(5):690-2. https://doi.org/10.5811/westjem.2015.6.26082 https://doi.org/10.5811/westjem.2015.6.2... ). - CPR initiation according to the AHA guidelines in effect at the time of the study(²2 Movahedi A, Mirhafez SR, Behnam-Voshani H, Reihani H, Kavosi A, Ferns GA, et al. A Comparison of the effect of interposed abdominal compression cardiopulmonary resuscitation and standard cardiopulmonary resuscitation methods on end-tidal CO2 and the return of spontaneous circulation following cardiac arrest: a clinical trial. Acad Emerg Med. 2016;23(4):448-54. https://doi.org/10.1111/acem.12903 https://doi.org/10.1111/acem.12903... ,¹¹11 Berryman CR, Phillips GM. Interposed abdominal compression-CPR in human subjects. Ann Emerg Med. 1984;13(4):226-9. https://doi.org/10.1016/s0196-0644(84)80467-9 https://doi.org/10.1016/s0196-0644(84)80... ,¹³13 Mateer JR, Stueven HA, Thompson BM, Aprahamian C, Darin JC. Pre-hospital IAC-CPR versus standard CPR: paramedic resuscitation of cardiac arrests. Am J Emerg Med. 1985;3(2):143-6. https://doi.org/10.1016/0735-6757(85)90038-5 https://doi.org/10.1016/0735-6757(85)900... 14 Howard M, Carrubba C, Foss F, Janiak B, Hogan B, Guinness M. Interposed abdominal compression-CPR: Its effects on parameters of coronary perfusion in human subjects. Ann Emerg Med. 1987;16(3):253-9. https://doi.org/10.1016/s0196-0644(87)80169-5 https://doi.org/10.1016/s0196-0644(87)80... -¹⁵15 Ward KR, Sullivan RJ, Zelenak RR, Summer WR. A comparison of interposed abdominal compression CPR and standard CPR by monitoring end-tidal PCO2. Ann Emerg Med. 1989;18(8):831-7. https://doi.org/10.1016/s0196-0644(89)80206-9 https://doi.org/10.1016/s0196-0644(89)80... ,¹⁷17 Sack JB, Kesselbrenner MB, Jarrad A. Interposed abdominal compression-cardiopulmonary resuscitation and resuscitation outcome during asystole and electromechanical dissociation. Circ. 1992;86(6):1692-700. https://doi.org/10.1161/01.cir.86.6.1692 https://doi.org/10.1161/01.cir.86.6.1692... 18 Sack JB. Survival from in-hospital cardiac arrest with interposed abdominal counterpulsation during cardiopulmonary resuscitation. JAMA. 1992;267(3):379. https://doi.org/10.1001/jama.1992.03480030057037 https://doi.org/10.1001/jama.1992.034800... -¹⁹19 Adams CP, Martin GB, Rivers EP, Ward K, Smithline HA, Rady MY. Hemodynamics of interposed abdominal compression during human cardiopulmonary resuscitation. Acad Emerg Med. 1994;1(5):498-502. https://doi.org/10.1111/j.1553-2712.1994.tb02536.x https://doi.org/10.1111/j.1553-2712.1994... ,²²22 Li J, Wang J, Li T. Interposed abdominal compression-cardiopulmonary resuscitation after cardiac surgery. Interact Cardiovasc Thorac Surg. 2014;19(6):985-9. https://doi.org/10.1093/icvts/ivu255 https://doi.org/10.1093/icvts/ivu255... -²³23 McClung C, Anshus A. Interposed Abdominal Compression CPR for an Out-of Hospital Cardiac Arrest Victim Failing Traditional CPR. West J Emerg Med. 2015;16(5):690-2. https://doi.org/10.5811/westjem.2015.6.26082 https://doi.org/10.5811/westjem.2015.6.2... ). - Orotracheal intubation performed during advanced life support(¹³13 Mateer JR, Stueven HA, Thompson BM, Aprahamian C, Darin JC. Pre-hospital IAC-CPR versus standard CPR: paramedic resuscitation of cardiac arrests. Am J Emerg Med. 1985;3(2):143-6. https://doi.org/10.1016/0735-6757(85)90038-5 https://doi.org/10.1016/0735-6757(85)900... ,¹⁵15 Ward KR, Sullivan RJ, Zelenak RR, Summer WR. A comparison of interposed abdominal compression CPR and standard CPR by monitoring end-tidal PCO2. Ann Emerg Med. 1989;18(8):831-7. https://doi.org/10.1016/s0196-0644(89)80206-9 https://doi.org/10.1016/s0196-0644(89)80... ,¹⁷17 Sack JB, Kesselbrenner MB, Jarrad A. Interposed abdominal compression-cardiopulmonary resuscitation and resuscitation outcome during asystole and electromechanical dissociation. Circ. 1992;86(6):1692-700. https://doi.org/10.1161/01.cir.86.6.1692 https://doi.org/10.1161/01.cir.86.6.1692... ,²³23 McClung C, Anshus A. Interposed Abdominal Compression CPR for an Out-of Hospital Cardiac Arrest Victim Failing Traditional CPR. West J Emerg Med. 2015;16(5):690-2. https://doi.org/10.5811/westjem.2015.6.26082 https://doi.org/10.5811/westjem.2015.6.2... ). - Defibrillation performed for shockable rhythms(¹³13 Mateer JR, Stueven HA, Thompson BM, Aprahamian C, Darin JC. Pre-hospital IAC-CPR versus standard CPR: paramedic resuscitation of cardiac arrests. Am J Emerg Med. 1985;3(2):143-6. https://doi.org/10.1016/0735-6757(85)90038-5 https://doi.org/10.1016/0735-6757(85)900... ). - Interposed abdominal compression during the relaxation phase of chest compression(²2 Movahedi A, Mirhafez SR, Behnam-Voshani H, Reihani H, Kavosi A, Ferns GA, et al. A Comparison of the effect of interposed abdominal compression cardiopulmonary resuscitation and standard cardiopulmonary resuscitation methods on end-tidal CO2 and the return of spontaneous circulation following cardiac arrest: a clinical trial. Acad Emerg Med. 2016;23(4):448-54. https://doi.org/10.1111/acem.12903 https://doi.org/10.1111/acem.12903... ,¹³13 Mateer JR, Stueven HA, Thompson BM, Aprahamian C, Darin JC. Pre-hospital IAC-CPR versus standard CPR: paramedic resuscitation of cardiac arrests. Am J Emerg Med. 1985;3(2):143-6. https://doi.org/10.1016/0735-6757(85)90038-5 https://doi.org/10.1016/0735-6757(85)900... -¹⁴14 Howard M, Carrubba C, Foss F, Janiak B, Hogan B, Guinness M. Interposed abdominal compression-CPR: Its effects on parameters of coronary perfusion in human subjects. Ann Emerg Med. 1987;16(3):253-9. https://doi.org/10.1016/s0196-0644(87)80169-5 https://doi.org/10.1016/s0196-0644(87)80... ,¹⁶16 Barranco F, Lesmes A, Irles JA, Blasco J, Leal J, Rodriguez J, et al. Cardiopulmonary resuscitation with simultaneous chest and abdominal compression: comparative study in humans. Resusc. 1990;20(1):67-77. https://doi.org/10.1016/0300-9572(90)90088-v https://doi.org/10.1016/0300-9572(90)900... 17 Sack JB, Kesselbrenner MB, Jarrad A. Interposed abdominal compression-cardiopulmonary resuscitation and resuscitation outcome during asystole and electromechanical dissociation. Circ. 1992;86(6):1692-700. https://doi.org/10.1161/01.cir.86.6.1692 https://doi.org/10.1161/01.cir.86.6.1692... -¹⁸18 Sack JB. Survival from in-hospital cardiac arrest with interposed abdominal counterpulsation during cardiopulmonary resuscitation. JAMA. 1992;267(3):379. https://doi.org/10.1001/jama.1992.03480030057037 https://doi.org/10.1001/jama.1992.034800... ,²³23 McClung C, Anshus A. Interposed Abdominal Compression CPR for an Out-of Hospital Cardiac Arrest Victim Failing Traditional CPR. West J Emerg Med. 2015;16(5):690-2. https://doi.org/10.5811/westjem.2015.6.26082 https://doi.org/10.5811/westjem.2015.6.2... -²⁴24 Zhang S, Liu Q, Han S, Zhang Z, Zhang Y, Liu Y, et al. Standard versus Abdominal Lifting and Compression CPR. J Evid Based Complementary Altern Med. 2016;1-8. https://doi.org/10.1155/2016/9416908 https://doi.org/10.1155/2016/9416908... ). - The depth, rate, and frequency of abdominal compressions follow the rhythms of chest compressions indicated by the AHA at the time of the study(¹⁷17 Sack JB, Kesselbrenner MB, Jarrad A. Interposed abdominal compression-cardiopulmonary resuscitation and resuscitation outcome during asystole and electromechanical dissociation. Circ. 1992;86(6):1692-700. https://doi.org/10.1161/01.cir.86.6.1692 https://doi.org/10.1161/01.cir.86.6.1692... -¹⁸18 Sack JB. Survival from in-hospital cardiac arrest with interposed abdominal counterpulsation during cardiopulmonary resuscitation. JAMA. 1992;267(3):379. https://doi.org/10.1001/jama.1992.03480030057037 https://doi.org/10.1001/jama.1992.034800... ,²²22 Li J, Wang J, Li T. Interposed abdominal compression-cardiopulmonary resuscitation after cardiac surgery. Interact Cardiovasc Thorac Surg. 2014;19(6):985-9. https://doi.org/10.1093/icvts/ivu255 https://doi.org/10.1093/icvts/ivu255... -²³23 McClung C, Anshus A. Interposed Abdominal Compression CPR for an Out-of Hospital Cardiac Arrest Victim Failing Traditional CPR. West J Emerg Med. 2015;16(5):690-2. https://doi.org/10.5811/westjem.2015.6.26082 https://doi.org/10.5811/westjem.2015.6.2... ,²⁵25 Li M, Song W, Ouyang Y, Wu D, Zhang J, Wang L, Li J. Clinical evaluation of active abdominal lifting and compression CPR in patients with cardiac arrest. Am J Emerg Med. 2017;35(12):1892-4. https://doi.org/10.1016/j.ajem.2017.06.031 https://doi.org/10.1016/j.ajem.2017.06.0... ). - Healthcare professionals positioned their hands on the victim’s abdomen. The base of the hands was placed about 3 cm to the left of the midline, and the fingers supported gently on the abdomen. With this positioning, the abdomen was compressed using the hypothenar and thenar regions of the hands along a craniocaudal line of the abdominal aorta(²²22 Li J, Wang J, Li T. Interposed abdominal compression-cardiopulmonary resuscitation after cardiac surgery. Interact Cardiovasc Thorac Surg. 2014;19(6):985-9. https://doi.org/10.1093/icvts/ivu255 https://doi.org/10.1093/icvts/ivu255... ). - Abdominal compressions were performed to the left of the midline to preferentially compress the abdominal aorta and minimize compression of the vena cava(¹⁵15 Ward KR, Sullivan RJ, Zelenak RR, Summer WR. A comparison of interposed abdominal compression CPR and standard CPR by monitoring end-tidal PCO2. Ann Emerg Med. 1989;18(8):831-7. https://doi.org/10.1016/s0196-0644(89)80206-9 https://doi.org/10.1016/s0196-0644(89)80... ,¹⁹19 Adams CP, Martin GB, Rivers EP, Ward K, Smithline HA, Rady MY. Hemodynamics of interposed abdominal compression during human cardiopulmonary resuscitation. Acad Emerg Med. 1994;1(5):498-502. https://doi.org/10.1111/j.1553-2712.1994.tb02536.x https://doi.org/10.1111/j.1553-2712.1994... -²⁰20 Villa GF, Colombo S, Cabrini L, Scandroglio AM, Torri G. Interposed abdominal compression in mechanical cardiopulmonary resuscitation: description of a clinical case. Minerva Anestesiol [Internet]. 1998[cited 2022 Aug 20];64(9):415-8. Available from: https://pubmed.ncbi.nlm.nih.gov/9835731/ https://pubmed.ncbi.nlm.nih.gov/9835731/... ). - Abdominal compressions were performed with the hands open, one on top of the other, centered over the umbilicus(¹¹11 Berryman CR, Phillips GM. Interposed abdominal compression-CPR in human subjects. Ann Emerg Med. 1984;13(4):226-9. https://doi.org/10.1016/s0196-0644(84)80467-9 https://doi.org/10.1016/s0196-0644(84)80... ,¹³13 Mateer JR, Stueven HA, Thompson BM, Aprahamian C, Darin JC. Pre-hospital IAC-CPR versus standard CPR: paramedic resuscitation of cardiac arrests. Am J Emerg Med. 1985;3(2):143-6. https://doi.org/10.1016/0735-6757(85)90038-5 https://doi.org/10.1016/0735-6757(85)900... ,¹⁷17 Sack JB, Kesselbrenner MB, Jarrad A. Interposed abdominal compression-cardiopulmonary resuscitation and resuscitation outcome during asystole and electromechanical dissociation. Circ. 1992;86(6):1692-700. https://doi.org/10.1161/01.cir.86.6.1692 https://doi.org/10.1161/01.cir.86.6.1692... -¹⁸18 Sack JB. Survival from in-hospital cardiac arrest with interposed abdominal counterpulsation during cardiopulmonary resuscitation. JAMA. 1992;267(3):379. https://doi.org/10.1001/jama.1992.03480030057037 https://doi.org/10.1001/jama.1992.034800... ), between the xiphoid process and the umbilicus(²⁴24 Zhang S, Liu Q, Han S, Zhang Z, Zhang Y, Liu Y, et al. Standard versus Abdominal Lifting and Compression CPR. J Evid Based Complementary Altern Med. 2016;1-8. https://doi.org/10.1155/2016/9416908 https://doi.org/10.1155/2016/9416908... ), or in the epigastric region(¹¹11 Berryman CR, Phillips GM. Interposed abdominal compression-CPR in human subjects. Ann Emerg Med. 1984;13(4):226-9. https://doi.org/10.1016/s0196-0644(84)80467-9 https://doi.org/10.1016/s0196-0644(84)80... ). - For intubated patients, ventilation was performed using a bag-valve-mask device(²2 Movahedi A, Mirhafez SR, Behnam-Voshani H, Reihani H, Kavosi A, Ferns GA, et al. A Comparison of the effect of interposed abdominal compression cardiopulmonary resuscitation and standard cardiopulmonary resuscitation methods on end-tidal CO2 and the return of spontaneous circulation following cardiac arrest: a clinical trial. Acad Emerg Med. 2016;23(4):448-54. https://doi.org/10.1111/acem.12903 https://doi.org/10.1111/acem.12903... .¹⁷17 Sack JB, Kesselbrenner MB, Jarrad A. Interposed abdominal compression-cardiopulmonary resuscitation and resuscitation outcome during asystole and electromechanical dissociation. Circ. 1992;86(6):1692-700. https://doi.org/10.1161/01.cir.86.6.1692 https://doi.org/10.1161/01.cir.86.6.1692... -¹⁸18 Sack JB. Survival from in-hospital cardiac arrest with interposed abdominal counterpulsation during cardiopulmonary resuscitation. JAMA. 1992;267(3):379. https://doi.org/10.1001/jama.1992.03480030057037 https://doi.org/10.1001/jama.1992.034800... ,²¹21 Rottenberg EM, Heard J, Hamlin R, Sun BC, Awad H. Abdominal only CPR during cardiac arrest for a patient with an LVAD during resternotomy: a case report. J Cardiothorac Surg. 2011;6(1):1-4. https://doi.org/10.1186/1749-80906-91 https://doi.org/10.1186/1749-80906-91... ). - Medications were administered following the AHA protocol in effect at the time of the study(¹¹11 Berryman CR, Phillips GM. Interposed abdominal compression-CPR in human subjects. Ann Emerg Med. 1984;13(4):226-9. https://doi.org/10.1016/s0196-0644(84)80467-9 https://doi.org/10.1016/s0196-0644(84)80... -¹²12 McDonald JL. Effect of interposed abdominal compression during CPR on central arterial and venous pressures. Am J Emerg Med. 1985;3(2):156-9. https://doi.org/10.1016/0735-6757(85)90041-5 https://doi.org/10.1016/0735-6757(85)900... ,¹⁴14 Howard M, Carrubba C, Foss F, Janiak B, Hogan B, Guinness M. Interposed abdominal compression-CPR: Its effects on parameters of coronary perfusion in human subjects. Ann Emerg Med. 1987;16(3):253-9. https://doi.org/10.1016/s0196-0644(87)80169-5 https://doi.org/10.1016/s0196-0644(87)80... ,¹⁷17 Sack JB, Kesselbrenner MB, Jarrad A. Interposed abdominal compression-cardiopulmonary resuscitation and resuscitation outcome during asystole and electromechanical dissociation. Circ. 1992;86(6):1692-700. https://doi.org/10.1161/01.cir.86.6.1692 https://doi.org/10.1161/01.cir.86.6.1692... ,²¹21 Rottenberg EM, Heard J, Hamlin R, Sun BC, Awad H. Abdominal only CPR during cardiac arrest for a patient with an LVAD during resternotomy: a case report. J Cardiothorac Surg. 2011;6(1):1-4. https://doi.org/10.1186/1749-80906-91 https://doi.org/10.1186/1749-80906-91... ,²³23 McClung C, Anshus A. Interposed Abdominal Compression CPR for an Out-of Hospital Cardiac Arrest Victim Failing Traditional CPR. West J Emerg Med. 2015;16(5):690-2. https://doi.org/10.5811/westjem.2015.6.26082 https://doi.org/10.5811/westjem.2015.6.2... ).
Primary Outcome	Secondary Outcome
- Abdominal compression and elevation had a statistically significantly higher restoration of spontaneous circulation compared to the rate of chest compression [(p < 0.01)(²⁵25 Li M, Song W, Ouyang Y, Wu D, Zhang J, Wang L, Li J. Clinical evaluation of active abdominal lifting and compression CPR in patients with cardiac arrest. Am J Emerg Med. 2017;35(12):1892-4. https://doi.org/10.1016/j.ajem.2017.06.031 https://doi.org/10.1016/j.ajem.2017.06.0... ), (p= 0.049)(²⁴24 Zhang S, Liu Q, Han S, Zhang Z, Zhang Y, Liu Y, et al. Standard versus Abdominal Lifting and Compression CPR. J Evid Based Complementary Altern Med. 2016;1-8. https://doi.org/10.1155/2016/9416908 https://doi.org/10.1155/2016/9416908... )]. - The return of spontaneous circulation in the group that received interposed abdominal compressions was not significantly higher than the standard CPR group [(p> 0.50)(¹²12 McDonald JL. Effect of interposed abdominal compression during CPR on central arterial and venous pressures. Am J Emerg Med. 1985;3(2):156-9. https://doi.org/10.1016/0735-6757(85)90041-5 https://doi.org/10.1016/0735-6757(85)900... ,¹⁴14 Howard M, Carrubba C, Foss F, Janiak B, Hogan B, Guinness M. Interposed abdominal compression-CPR: Its effects on parameters of coronary perfusion in human subjects. Ann Emerg Med. 1987;16(3):253-9. https://doi.org/10.1016/s0196-0644(87)80169-5 https://doi.org/10.1016/s0196-0644(87)80... ), (p= 0.07)(¹⁵15 Ward KR, Sullivan RJ, Zelenak RR, Summer WR. A comparison of interposed abdominal compression CPR and standard CPR by monitoring end-tidal PCO2. Ann Emerg Med. 1989;18(8):831-7. https://doi.org/10.1016/s0196-0644(89)80206-9 https://doi.org/10.1016/s0196-0644(89)80... )]. - The return of spontaneous circulation in the group that received interposed abdominal compressions was significantly higher than the standard CPR group [(p> 0.05)(²²22 Li J, Wang J, Li T. Interposed abdominal compression-cardiopulmonary resuscitation after cardiac surgery. Interact Cardiovasc Thorac Surg. 2014;19(6):985-9. https://doi.org/10.1093/icvts/ivu255 https://doi.org/10.1093/icvts/ivu255... ), (p= 0.01)(¹⁷17 Sack JB, Kesselbrenner MB, Jarrad A. Interposed abdominal compression-cardiopulmonary resuscitation and resuscitation outcome during asystole and electromechanical dissociation. Circ. 1992;86(6):1692-700. https://doi.org/10.1161/01.cir.86.6.1692 https://doi.org/10.1161/01.cir.86.6.1692... ), (p= 0.007)(¹⁸18 Sack JB. Survival from in-hospital cardiac arrest with interposed abdominal counterpulsation during cardiopulmonary resuscitation. JAMA. 1992;267(3):379. https://doi.org/10.1001/jama.1992.03480030057037 https://doi.org/10.1001/jama.1992.034800... )]. - Return of spontaneous circulation in the studied patient(²⁰20 Villa GF, Colombo S, Cabrini L, Scandroglio AM, Torri G. Interposed abdominal compression in mechanical cardiopulmonary resuscitation: description of a clinical case. Minerva Anestesiol [Internet]. 1998[cited 2022 Aug 20];64(9):415-8. Available from: https://pubmed.ncbi.nlm.nih.gov/9835731/ https://pubmed.ncbi.nlm.nih.gov/9835731/... -²¹21 Rottenberg EM, Heard J, Hamlin R, Sun BC, Awad H. Abdominal only CPR during cardiac arrest for a patient with an LVAD during resternotomy: a case report. J Cardiothorac Surg. 2011;6(1):1-4. https://doi.org/10.1186/1749-80906-91 https://doi.org/10.1186/1749-80906-91... ,²³23 McClung C, Anshus A. Interposed Abdominal Compression CPR for an Out-of Hospital Cardiac Arrest Victim Failing Traditional CPR. West J Emerg Med. 2015;16(5):690-2. https://doi.org/10.5811/westjem.2015.6.26082 https://doi.org/10.5811/westjem.2015.6.2... ).	- Significant improvement in heart rate after resuscitation with active abdominal compression and elevation [(p < 0.01)(²⁵25 Li M, Song W, Ouyang Y, Wu D, Zhang J, Wang L, Li J. Clinical evaluation of active abdominal lifting and compression CPR in patients with cardiac arrest. Am J Emerg Med. 2017;35(12):1892-4. https://doi.org/10.1016/j.ajem.2017.06.031 https://doi.org/10.1016/j.ajem.2017.06.0... ), (p << 0.001)(²⁴24 Zhang S, Liu Q, Han S, Zhang Z, Zhang Y, Liu Y, et al. Standard versus Abdominal Lifting and Compression CPR. J Evid Based Complementary Altern Med. 2016;1-8. https://doi.org/10.1155/2016/9416908 https://doi.org/10.1155/2016/9416908... ), (p < 0.001)(²⁶26 Khanghah AG, Moghadamnia MT, Panahi L, Pouy S, Nargesi MA, Leyli EK. Effect of interposed abdominal compression on cardiopulmonary resuscitation outcomes: a randomized clinical trial. Archi Acad Emerg Med. 2022;10(1):e57-e57. https://doi.org/10.22037/aaem.v10i1.1678 https://doi.org/10.22037/aaem.v10i1.1678... )]. - Significant improvement in blood pressure after resuscitation with active abdominal compression and elevation [(p < 0.01)(²⁶26 Khanghah AG, Moghadamnia MT, Panahi L, Pouy S, Nargesi MA, Leyli EK. Effect of interposed abdominal compression on cardiopulmonary resuscitation outcomes: a randomized clinical trial. Archi Acad Emerg Med. 2022;10(1):e57-e57. https://doi.org/10.22037/aaem.v10i1.1678 https://doi.org/10.22037/aaem.v10i1.1678... ), (p = 0.003)(²⁴24 Zhang S, Liu Q, Han S, Zhang Z, Zhang Y, Liu Y, et al. Standard versus Abdominal Lifting and Compression CPR. J Evid Based Complementary Altern Med. 2016;1-8. https://doi.org/10.1155/2016/9416908 https://doi.org/10.1155/2016/9416908... ), (p = 0.001)(¹⁴14 Howard M, Carrubba C, Foss F, Janiak B, Hogan B, Guinness M. Interposed abdominal compression-CPR: Its effects on parameters of coronary perfusion in human subjects. Ann Emerg Med. 1987;16(3):253-9. https://doi.org/10.1016/s0196-0644(87)80169-5 https://doi.org/10.1016/s0196-0644(87)80... ), (p < 0.05)(¹²12 McDonald JL. Effect of interposed abdominal compression during CPR on central arterial and venous pressures. Am J Emerg Med. 1985;3(2):156-9. https://doi.org/10.1016/0735-6757(85)90041-5 https://doi.org/10.1016/0735-6757(85)900... ), (p < 0.001)(¹¹11 Berryman CR, Phillips GM. Interposed abdominal compression-CPR in human subjects. Ann Emerg Med. 1984;13(4):226-9. https://doi.org/10.1016/s0196-0644(84)80467-9 https://doi.org/10.1016/s0196-0644(84)80... ), (p = 0.003)(²⁸28 Wang JP, Zhang YM, Yang RJ, Zhang K, Chai MM, Zhou DC. Efficacy and safety of active abdominal compression-decompression versus standard CPR for cardiac arrests: a systematic review and meta-analysis of 17 RCTs. Int J Surg. 2019;71:132-9. https://doi.org/10.1016/j.ijsu.2019.09.026 https://doi.org/10.1016/j.ijsu.2019.09.0... )]. - Significant improvement in pulse oxygen saturation with active abdominal compression and elevation [(p < 0.01)(²⁵25 Li M, Song W, Ouyang Y, Wu D, Zhang J, Wang L, Li J. Clinical evaluation of active abdominal lifting and compression CPR in patients with cardiac arrest. Am J Emerg Med. 2017;35(12):1892-4. https://doi.org/10.1016/j.ajem.2017.06.031 https://doi.org/10.1016/j.ajem.2017.06.0... ), (p < 0.001)(²⁴24 Zhang S, Liu Q, Han S, Zhang Z, Zhang Y, Liu Y, et al. Standard versus Abdominal Lifting and Compression CPR. J Evid Based Complementary Altern Med. 2016;1-8. https://doi.org/10.1155/2016/9416908 https://doi.org/10.1155/2016/9416908... )]. - 24-hour survival was the same in both groups [(p = 1.00)(²2 Movahedi A, Mirhafez SR, Behnam-Voshani H, Reihani H, Kavosi A, Ferns GA, et al. A Comparison of the effect of interposed abdominal compression cardiopulmonary resuscitation and standard cardiopulmonary resuscitation methods on end-tidal CO2 and the return of spontaneous circulation following cardiac arrest: a clinical trial. Acad Emerg Med. 2016;23(4):448-54. https://doi.org/10.1111/acem.12903 https://doi.org/10.1111/acem.12903... )]. - 24-hour survival was statistically higher in the group that received interposed abdominal compressions [(p = 1.00)(¹⁷17 Sack JB, Kesselbrenner MB, Jarrad A. Interposed abdominal compression-cardiopulmonary resuscitation and resuscitation outcome during asystole and electromechanical dissociation. Circ. 1992;86(6):1692-700. https://doi.org/10.1161/01.cir.86.6.1692 https://doi.org/10.1161/01.cir.86.6.1692... ), (p = 0.009)(¹⁷17 Sack JB, Kesselbrenner MB, Jarrad A. Interposed abdominal compression-cardiopulmonary resuscitation and resuscitation outcome during asystole and electromechanical dissociation. Circ. 1992;86(6):1692-700. https://doi.org/10.1161/01.cir.86.6.1692 https://doi.org/10.1161/01.cir.86.6.1692... )]. - CPR with interposed abdominal compression increased expired CO2 during resuscitation [(p < 0.003)(²⁵25 Li M, Song W, Ouyang Y, Wu D, Zhang J, Wang L, Li J. Clinical evaluation of active abdominal lifting and compression CPR in patients with cardiac arrest. Am J Emerg Med. 2017;35(12):1892-4. https://doi.org/10.1016/j.ajem.2017.06.031 https://doi.org/10.1016/j.ajem.2017.06.0... ), (p = 0.001)(¹⁵15 Ward KR, Sullivan RJ, Zelenak RR, Summer WR. A comparison of interposed abdominal compression CPR and standard CPR by monitoring end-tidal PCO2. Ann Emerg Med. 1989;18(8):831-7. https://doi.org/10.1016/s0196-0644(89)80206-9 https://doi.org/10.1016/s0196-0644(89)80... )]. - Significantly higher hospital discharge rate in the group that received CPR with abdominal compression [(p < 0.05)(²²22 Li J, Wang J, Li T. Interposed abdominal compression-cardiopulmonary resuscitation after cardiac surgery. Interact Cardiovasc Thorac Surg. 2014;19(6):985-9. https://doi.org/10.1093/icvts/ivu255 https://doi.org/10.1093/icvts/ivu255... ), (p = 0.02)(¹⁸18 Sack JB. Survival from in-hospital cardiac arrest with interposed abdominal counterpulsation during cardiopulmonary resuscitation. JAMA. 1992;267(3):379. https://doi.org/10.1001/jama.1992.03480030057037 https://doi.org/10.1001/jama.1992.034800... )]. - No complications related to interposed abdominal compressions in the group of patients who underwent autopsy(¹¹11 Berryman CR, Phillips GM. Interposed abdominal compression-CPR in human subjects. Ann Emerg Med. 1984;13(4):226-9. https://doi.org/10.1016/s0196-0644(84)80467-9 https://doi.org/10.1016/s0196-0644(84)80... ,¹⁶16 Barranco F, Lesmes A, Irles JA, Blasco J, Leal J, Rodriguez J, et al. Cardiopulmonary resuscitation with simultaneous chest and abdominal compression: comparative study in humans. Resusc. 1990;20(1):67-77. https://doi.org/10.1016/0300-9572(90)90088-v https://doi.org/10.1016/0300-9572(90)900... -¹⁷17 Sack JB, Kesselbrenner MB, Jarrad A. Interposed abdominal compression-cardiopulmonary resuscitation and resuscitation outcome during asystole and electromechanical dissociation. Circ. 1992;86(6):1692-700. https://doi.org/10.1161/01.cir.86.6.1692 https://doi.org/10.1161/01.cir.86.6.1692... ). - Higher intravascular pressure during simultaneous chest and abdominal compressions(¹⁶16 Barranco F, Lesmes A, Irles JA, Blasco J, Leal J, Rodriguez J, et al. Cardiopulmonary resuscitation with simultaneous chest and abdominal compression: comparative study in humans. Resusc. 1990;20(1):67-77. https://doi.org/10.1016/0300-9572(90)90088-v https://doi.org/10.1016/0300-9572(90)900... ). - Regurgitation did not occur in any patients(¹²12 McDonald JL. Effect of interposed abdominal compression during CPR on central arterial and venous pressures. Am J Emerg Med. 1985;3(2):156-9. https://doi.org/10.1016/0735-6757(85)90041-5 https://doi.org/10.1016/0735-6757(85)900... -¹³13 Mateer JR, Stueven HA, Thompson BM, Aprahamian C, Darin JC. Pre-hospital IAC-CPR versus standard CPR: paramedic resuscitation of cardiac arrests. Am J Emerg Med. 1985;3(2):143-6. https://doi.org/10.1016/0735-6757(85)90038-5 https://doi.org/10.1016/0735-6757(85)900... ).
Indications	Contraindications
- Adults aged 18 years or older with non-traumatic cardiac arrest.	-Patients with a history of abdominal aortic aneurysm, diaphragm rupture, abdominal mass, abdominal bleeding, cancer in abdominal organs, coagulopathy, hepatosplenomegaly, recent abdominal surgery, intestinal obstruction, ascites, ovarian cyst, and pregnancy or suspected pregnancy.

[1] Corresponding author: Dariane Veríssimo de Araújo, E-mail: dariane.verissimo@gmail.com

Brasil

Brasil

Abdominal compressions during cardiopulmonary resuscitation: a scoping review

Compresiones abdominales durante la reanimación cardiopulmonar: una revisión de alcance

ABSTRACT

Objectives:

Methods:

Results:

Conclusions: