Effectiveness of different compression-to-ventilation methods for cardiopulmonary resuscitation: A systematic review. (September 2017)

• Record Type: Journal Article
• Authors: Ashoor, Huda M.; Lillie, Erin; Zarin, Wasifa; Pham, Ba'; Khan, Paul A.; Nincic, Vera; Yazdi, Fatemeh; Ghassemi, Marco; Ivory, John; Cardoso, Roberta; Perkins, Gavin D.; de Caen, Allan R.; Tricco, Andrea C.
• Is Part Of: Resuscitation. Volume 118(2017)
• Page Start: 112
• Page End: 125
• Publication Date: 2017-09
• Subjects: CA cardiac arrest -- CC-CPR continuous compression CPR -- CI confidence interval -- CO-CPR compression-only CPR -- CPR cardiopulmonary resuscitation -- EMS emergency medical service -- EPOC Effective Practice and Organization of Care -- GRADE Grading of Recommendation, Assessment, Development, and Evaluation -- ILCOR BLS International Liaison Committee on Resuscitation Basic Life Support -- MICR minimally-interrupted cardiac resuscitation -- OHCA out-of-hospital cardiac arrest -- OR odds ratio -- PICOST Population, Intervention, Control, Outcomes, Study design and Timeframe -- PRESS Peer Review of Electronic Search Strategies -- PRISMA-P Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols -- RCTs randomised controlled trials -- RD risk differences -- ROSC return of spontaneous circulation -- RR risk ratio -- SD standard deviation; Cardiac arrest -- Cardiopulmonary resuscitation -- Ventilation -- Chest compression -- Bystander CPR -- Functional neurological outcome -- Survival -- Rate of Return to Spontaneous Circulation -- ROSC -- Quality of life; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2017.05.032
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Aim: To compare the effectiveness of different compression-to-ventilation methods during cardiopulmonary resuscitation (CPR) in patients with cardiac arrest. Methods: We searched MEDLINE and Cochrane Central Register of Controlled Trials from inception until January 2016. We included experimental, quasi-experimental, and observational studies that compared different chest compression-to-ventilation ratios during CPR for all patients and assessed at least one of the following outcomes: favourable neurological outcomes, survival, return of spontaneous circulation (ROSC), and quality of life. Two reviewers independently screened literature search results, abstracted data, and appraised the risk of bias. Random-effects meta-analyses were conducted separately for randomised and non-randomised studies, as well as study characteristics, such as CPR provider. Results: After screening 5703 titles and abstracts and 229 full-text articles, we included 41 studies, of which 13 were companion reports. For adults receiving bystander or dispatcher-instructed CPR, no significant differences were observed across all comparisons and outcomes. Significantly less adults receiving bystander-initiated or plus dispatcher-instructed compression-only CPR experienced favourable neurological outcomes, survival, and ROSC compared to CPR 30:2 (compression-to-ventilation) in un-adjusted analyses in a large cohort study. Evidence from emergency medical service (EMS) CPR providers showed significantly more adults receiving CPR 30:2 experiencing improved favourable neurological outcomes and survival versus those receiving CPR 15:2. Significantly more children receiving CPR 15:2 or 30:2 experienced favourable neurological outcomes, survival, and greater ROSC compared to compression-only CPR. However, for children <1 years of age, no significant differences were observed between CPR 15:2 or 30:2 and compression-only CPR. Conclusions: Our results demonstrated that for adults, CPR 30:2 is associated with better survival and favourable neurological outcomes when compared to CPR 15:2. For children, more patients receiving CPR with either 15:2 or 30:2 compression-to ventilation ratio experienced favourable neurological function, survival, and ROSC when compared to CO-CPR for children of all ages, but for children <1 years of age, no statistically significant differences were observed.