Road to 2015 Guidelines: Chest compression only CPR vs conventional CPR

Road to 2015 Guidelines: Chest compression only CPR vs conventional CPR

ilcor_400x400ILCOR Scientific Evidence Evaluation and Review System
Questions Open for Public Comment
Closing Date – February 28, 2015
Question page HERE

Among adults who are in cardiac arrest outside of a hospital (P), does provision of chest compressions (without ventilation) by untrained/trained laypersons (I), compared with chest compressions with ventilation (C), change Survival with Favorable neurological/functional outcome at discharge, 30 days, 60 days, 180 days AND/OR 1 year, Survival only at discharge, 30 days, 60 days, 180 days AND/OR 1 year, ROSC, bystander CPR performance, CPR quality (O)?

The information provided is currently in DRAFT format and is NOT a FINAL version
Consensus on Science:
For “survival to one year with favourable neurological outcome” we have identified very low quality evidence (downgraded for risk of bias, indirectness, and imprecision) from one observational trial (Iwami 2007 2900) enrolling 1327 patients showing no significant difference between compression only and standard CPR (OR 0.98, 95%CI: 0.54, 1.77).

For “survival to 30 days with favourable neurological outcome” we identified very quality evidence (downgraded for risk of bias and indirectness) from 4 observational studies (Kitamura 2010 293, Kitamura 2011 3, Ong 2008 119, SOS-Kanto 2007 290) enrolling 40,646 patients demonstrating no significant difference between compression only and standard CPR. Three moderate quality evidence RCTs (each downgraded for indirectness) demonstrated no significant difference in outcomes between compression only CPR and standard CPR for 30d survival (Svensson 2010 434, OR 1.24 95%CI: 0.85-1.81), hospital discharge with favourable neuro outcome (Rea 2010 423, OR 1.25 95%CI 0.94-1.66), and hospital discharge (Hallstrom 2000 146, OR 1.4 95%CI: 0.88-2.22).

For “survival to 30 days” we identified very low quality evidence (downgraded for risk of bias and indirectness) from 2 observational studies (Bohm 2007 2908, Holmberg 2001 511) enrolling 11,444 patients demonstrating no significant difference between compression only and standard CPR.

For “survival to 14 days” we identified low quality evidence (downgraded for risk of bias indirectness) from 1 observational study (Bossaert 2007 2908) enrolling 829 patients demonstrating no significant difference between compression only and standard CPR (OR 0.76 95%CI: 0.46-1.24).

For “survival to discharge with favourable neurological outcome” we identified very low quality evidence (downgraded for risk of bias, inconsistency and indirectness) from 3 observational studies (Bobrow 2010 1447, Olasveengen 2008 214, and Panchal 2013 435) enrolling 2195 patients demonstrating no significant difference between compression only and standard CPR.

For “survival to discharge” we identified very low quality evidence (downgraded for risk of bias, inconsistency and indirectness) from 2 observational study (Gallagher 1995 1922, Mohler 2011 822,) demonstrating no enrolling 2486 patients demonstrating no significant difference between compression only and standard CPR.

The information provided is currently in DRAFT format and is NOT a FINAL version

Treatment Recommendation:

We recommend all rescuers should perform chest compressions for all patients in cardiac arrest (strong recommendation, moderate quality of evidence) We recommend chest compressions alone for untrained laypersons responding to cardiac arrest victims (strong recommendation, low quality of evidence). We suggest performing chest compressions alone for trained laypersons if they are incapable of delivering airway and breathing manoeuvres to cardiac arrest victims (weak recommendation, very low quality of evidence). We suggest the addition of ventilations for trained laypersons who are capable of giving CPR with ventilations to cardiac arrest victims and willing to do so (weak recommendation, very low quality of evidence). This recommendation places a relatively high value in [1] harm avoidance (not performing CPR or performing ineffective chest compressions and ventilations) and [2] simplifying resuscitation logistics, than potential benefit of an intervention of routine ventilations and compressions.

 

Question page HERE

 

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