Abstract / Summary
Abstract This systematic review and meta-analysis evaluated the clinical efficacy and safety of active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) compared with standard cardiopulmonary resuscitation (STD-CPR) in patients experiencing cardiac arrest (CA). We systematically searched 11 databases from inception to November 2025, including eight randomized controlled trials. Outcomes assessed included return of spontaneous circulation (ROSC), survival, neurological outcomes, hemodynamic parameters, arterial blood gas parameters, oxygen metabolism parameters, and adverse events. Data analysis was performed using RevMan 5.4.1, and certainty of evidence was assessed using the grading of recommendations assessment, development, and evaluation (GRADE) framework. AACD-CPR was associated with a higher return of spontaneous circulation (ROSC) rate and a shorter time to ROSC, whereas 2-week survival did not differ significantly between groups. Several exploratory physiological outcomes showed between-group differences, but substantial heterogeneity was present and many estimates were based on only two or three small studies. Rib fractures were less frequent in two studies, while evidence for other adverse events was limited. The certainty of evidence ranged from very low to moderate. AACD-CPR represents a promising resuscitation approach, but the current evidence remains insufficient to support broader clinical implementation. Larger multicenter randomized trials involving diverse populations are needed to evaluate clinically meaningful outcomes, including survival to hospital discharge, long-term survival, neurologically favorable survival, and procedure-related safety.