Abstract 4361233: Interposed Abdominal Compression CPR Associated With Improved Hemodynamic and Clinical Outcomes: A Systematic Review and Meta-Analysis

Background: Interposed abdominal compression cardiopulmonary resuscitation (IAC-CPR) has been proposed as a novel approach to augment forward blood flow and improve resuscitation outcomes in cardiac arrest. However, its clinical efficacy and hemodynamic advantages compared to standard CPR remain incompletely defined. Objective: To assess the impact of IAC-CPR versus standard CPR on hemodynamic parameters and clinically meaningful outcomes in adult patients undergoing resuscitation. Methods: A systematic review and meta-analysis was conducted adhering to PRISMA guidelines. Outcomes assessed included return of spontaneous circulation (ROSC), survival to hospital discharge, favorable neurological recovery (CPC 1–2), and hemodynamic parameters: mean arterial pressure (MAP), end-tidal CO2 (ETCO2), and CPR duration. Meta-analyses were performed using random-effects models with Hedges’ g or odds ratios (OR) where appropriate. Heterogeneity was evaluated via I2 and τ2 statistics. Results: 11 studies with a combined total of 1,025 patients (IAC: 581; Standard: 444) was included. ROSC was significantly higher in the IAC group (OR = 1.78, 95% CI [1.16, 2.74]; p = 0.014; I2 = 27.5%). Survival to discharge showed a trend favoring IAC (OR = 2.09, 95% CI [0.74, 5.88]; p = 0.092). Favorable neurological outcome (CPC 1–2) was significantly improved with IAC (OR = 3.34, 95% CI [1.67, 6.66]; p = 0.017). MAP was significantly higher with IAC-CPR (SMD = 1.62, 95% CI [1.47, 1.78]; p < 0.001). ETCO2 was significantly elevated in IAC (SMD = 1.31, 95% CI [1.10, 1.53]; p < 0.001). CPR duration was shorter in IAC (SMD = –0.12, 95% CI [–0.19, –0.05]; p = 0.006). There was minimal statistical heterogeneity in most outcomes (I2 = 0% for MAP, ETCO2, CPC, and duration). Conclusions: IAC-CPR significantly improves hemodynamic variables and is associated with better ROSC and favorable neurological outcomes compared to standard CPR. While survival to discharge showed a favorable trend, further high-quality RCTs are warranted to confirm long-term benefits. IAC-CPR may represent a promising adjunctive strategy during advanced cardiac life support.