GW29-e0549 Meta-analysis of mechanical versus manual chest compressions in cardiopulmonary resuscitation

IntroductionCardiac arrest is a leading cause of death in industrialised countries. Cardiopulmonary resuscitation (CPR) guidelines follow the principles of closed chest compression as described for the first time in 1960. Mechanical CPR devices are designed to improve chest compression quality, thus considering the improvement of resuscitation outcomes. This protocol outlines a systematic review and meta-analysis methodology to assess trials investigating the therapeutic effect of automated mechanical CPR devices at the rate of return of spontaneous circulation, neurological state and secondary endpoints (including short-term and long-term survival, injuries and surrogate parameters for CPR quality) in comparison with manual chest compressions in adults with cardiac arrest.Methods and analysisA sensitive search strategy will be employed in established bibliographic databases from inception until the date of search, followed by forward and backward reference searching. We will include randomised and quasi-randomised trials in qualitative analysis thus comparing mechanical to manual CPR. Studies reporting survival outcomes will be included in quantitative analysis. Two reviewers will assess independently publications using a predefined data collection form. Standardised tools will be used for data extraction, risks of bias and quality of evidence. If enough studies are identified for meta-analysis, the measures of association will be calculated by dint of bivariate random-effects models. Statistical heterogeneity will be evaluated by I2-statistics and explored through sensitivity analysis. By comprehensive subgroup analysis we intend to identify subpopulations who may benefit from mechanical or manual CPR techniques. The reporting follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Ethics and disseminationNo ethical approval will be needed because data from previous studies will be retrieved and analysed. Most resuscitation studies are conducted under an emergency exception for informed consent. This publication contains data deriving from a dissertation project. We will disseminate the results through publication in a peer-reviewed journal and at scientific conferences.PROSPERO registration numberCRD42017051633.

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Standard cardiopulmonary resuscitation versus chest compressions only after out-of-hospital cardiac arrest: a protocol for systematic review and meta-analysis

10.37766/inplasy2021.3.0109 ◽

2021 ◽

Author(s):

Qin Qin

Keyword(s):

Systematic Review ◽

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Meta Analysis ◽

Chest Compressions ◽

Hospital Cardiac Arrest

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Impact of therapeutic hypothermia during cardiopulmonary resuscitation on neurologic outcome: A systematic review and meta-analysis

Resuscitation ◽

10.1016/j.resuscitation.2021.01.029 ◽

2021 ◽

Author(s):

Filippo Annoni ◽

Lorenzo Peluso ◽

Marco Fiore ◽

Per Nordberg ◽

Leif Svensson ◽

...

Keyword(s):

Systematic Review ◽

Cardiopulmonary Resuscitation ◽

Therapeutic Hypothermia ◽

Meta Analysis ◽

Neurologic Outcome

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Intraosseous versus intravenous vascular access during cardiopulmonary resuscitation for out-of-hospital cardiac arrest: a systematic review and meta-analysis of observational studies

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-021-00858-6 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Yu-Lin Hsieh ◽

Meng-Che Wu ◽

Jon Wolfshohl ◽

James d’Etienne ◽

Chien-Hua Huang ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Hospital Discharge ◽

Vascular Access ◽

Subgroup Analysis ◽

Observational Studies ◽

Primary Outcome ◽

Meta Analysis ◽

Cochrane Library ◽

Hospital Cardiac Arrest

Abstract Introduction This study is aimed to investigate the association of intraosseous (IO) versus intravenous (IV) route during cardiopulmonary resuscitation (CPR) with outcomes after out-of-hospital cardiac arrest (OHCA). Methods We systematically searched PubMed, Embase, Cochrane Library and Web of Science from the database inception through April 2020. Our search strings included designed keywords for two concepts, i.e. vascular access and cardiac arrest. There were no limitations implemented in the search strategy. We selected studies comparing IO versus IV access in neurological or survival outcomes after OHCA. Favourable neurological outcome at hospital discharge was pre-specified as the primary outcome. We pooled the effect estimates in random-effects models and quantified the heterogeneity by the I2 statistics. Time to intervention, defined as time interval from call for emergency medical services to establishing vascular access or administering medications, was hypothesized to be a potential outcome moderator and examined in subgroup analysis with meta-regression. Results Nine retrospective observational studies involving 111,746 adult OHCA patients were included. Most studies were rated as high quality according to Newcastle-Ottawa Scale. The pooled results demonstrated no significant association between types of vascular access and the primary outcome (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.27–1.33; I2, 95%). In subgroup analysis, time to intervention was noted to be positively associated with the pooled OR of achieving the primary outcome (OR: 3.95, 95% CI, 1.42–11.02, p: 0.02). That is, when the studies not accounting for the variable of “time to intervention” in the statistical analysis were pooled together, the meta-analytic results between IO access and favourable outcomes would be biased toward inverse association. No obvious publication bias was detected by the funnel plot. Conclusions The meta-analysis revealed no significant association between types of vascular access and neurological outcomes at hospital discharge among OHCA patients. Time to intervention was identified to be an important outcome moderator in this meta-analysis of observation studies. These results call for the need for future clinical trials to investigate the unbiased effect of IO use on OHCA CPR.

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Mechanical versus manual chest compressions for cardiac arrest: a systematic review and meta-analysis

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-016-0202-y ◽

2016 ◽

Vol 24 (1) ◽

Cited By ~ 25

Author(s):

Hui Li ◽

Dongping Wang ◽

Yi Yu ◽

Xiang Zhao ◽

Xiaoli Jing

Keyword(s):

Systematic Review ◽

Cardiac Arrest ◽

Meta Analysis ◽

Chest Compressions

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A shock advisory algorithm to analyse through chest compressions for reducing interruptions during cardiopulmonary resuscitation

Resuscitation ◽

10.1016/j.resuscitation.2017.08.026 ◽

2017 ◽

Vol 118 ◽

pp. e6 ◽

Cited By ~ 2

Author(s):

Chenguang Liu ◽

Stacy Gehman ◽

Dawn Jorgenson ◽

Tom Lyster ◽

Jason Coult ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Chest Compressions

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Chest compression efficacy of child resuscitators

Journal of Paramedic Practice ◽

10.12968/jpar.2021.13.11.448 ◽

2021 ◽

Vol 13 (11) ◽

pp. 448-455

Author(s):

Tiffany Wai Shan Lau ◽

Anthony Robert Lim ◽

Kyra Anne Len ◽

Loren Gene Yamamoto

Keyword(s):

Blood Flow ◽

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Minimum Weight ◽

Success Rates ◽

Compression Force ◽

Chest Compressions ◽

Traditional Methods ◽

Video Review ◽

Brief Training

Background: Chest compression efficacy determines blood flow in cardiopulmonary resuscitation (CPR) and relies on body mechanics, so resuscitator weight matters. Individuals of insufficient weight are incapable of generating a sufficient downward chest compression force using traditional methods. Aims: This study investigated how a resuscitator's weight affects chest compression efficacy, determined the minimum weight required to perform chest compressions and, for children and adults below this minimum weight, examine alternate means to perform chest compressions. Methods: Volunteers aged 8 years and above were enrolled to perform video-recorded, music-facilitated, compression-only CPR on an audible click-confirming manikin for 2 minutes, following brief training. Subjects who failed this proceeded to alternate modalities: chest compressions by jumping on the lower sternum; and squat-bouncing (bouncing the buttocks on the chest). These methods were assessed via video review. Findings: There were 57 subjects. The 30 subjects above 40kg were all able to complete nearly 200 compressions in 2 minutes. Success rates declined in those who weighed less than 40kg. Below 30 kg, only one subject (29.9 kg weight) out of 14 could achieve 200 effective compressions. Nearly all of the 23 subjects who could not perform conventional chest compressions were able to achieve effective chest compressions using alternate methods. Conclusion: A weight below 40kg resulted in a declining ability to perform standard chest compressions effectively. For small resuscitators, the jumping and squat-bouncing methods resulted in sufficient compressions most of the time; however, chest recoil and injuries are concerns.

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Effectiveness of a Dispatcher-Assisted Cardiopulmonary Resuscitation Program Developed by the Thailand National Institute of Emergency Medicine (NIEMS)

Prehospital and Disaster Medicine ◽

10.1017/s1049023x21001084 ◽

2021 ◽

pp. 1-6

Author(s):

Chuenruthai Angkoontassaneeyarat ◽

Chaiyaporn Yuksen ◽

Chetsadakon Jenpanitpong ◽

Pemika Rukthai ◽

Marisa Seanpan ◽

...

Keyword(s):

Health Care ◽

Emergency Medicine ◽

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Health Care Providers ◽

Care Providers ◽

Chest Compressions ◽

Threatening Condition ◽

Life Threatening

Abstract Background: Out-of-hospital cardiac arrest (OHCA) is a life-threatening condition with an overall survival rate that generally does not exceed 10%. Several factors play essential roles in increasing survival among patients experiencing cardiac arrest outside the hospital. Previous studies have reported that implementing a dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) program increases bystander CPR, quality of chest compressions, and patient survival. This study aimed to assess the effectiveness of a DA-CPR program developed by the Thailand National Institute for Emergency Medicine (NIEMS). Methods: This was an experimental study using a manikin model. The participants comprised both health care providers and non-health care providers aged 18 to 60 years. They were randomly assigned to either the DA-CPR group or the uninstructed CPR (U-CPR) group and performed chest compressions on a manikin model for two minutes. The sequentially numbered, opaque, sealed envelope method was used for randomization in blocks of four with a ratio of 1:1. Results: There were 100 participants in this study (49 in the DA-CPR group and 51 in the U-CPR group). Time to initiate chest compressions was statistically significantly longer in the DA-CPR group than in the U-CPR group (85.82 [SD = 32.54] seconds versus 23.94 [SD = 16.70] seconds; P <.001). However, the CPR instruction did not translate into better performance or quality of chest compressions for the overall sample or for health care or non-health care providers. Conclusion: Those in the CPR-trained group applied chest compressions (initiated CPR) more quickly than those who initiated CPR based upon dispatch-based CPR instructions.

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Abstract 20: Peripheral Intravenous Analysis Detects Return of Spontaneous Circulation Without Interruption of Chest Compressions in a Rat Model of Cardiopulmonary Resuscitation

Circulation ◽

10.1161/circ.140.suppl_2.20 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Claudius Balzer ◽

Franz J Baudenbacher ◽

Antonio Hernandez ◽

Michele M Salzman ◽

Matthias L Riess ◽

...

Keyword(s):

Mechanical Ventilation ◽

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Venous Pressure ◽

Fold Increase ◽

Spontaneous Circulation ◽

Arterial Line ◽

Chest Compressions ◽

Waveform Data ◽

Return Of Spontaneous Circulation

Introduction: A higher chest compression fraction (CCF) or percentage of time providing chest compressions is associated with improved survival after cardiac arrest (CA). Pauses in chest compression duration during cardiopulmonary resuscitation (CPR) to palpate a pulse can reduce the CCF. Peripheral Intravenous Analysis (PIVA) is a novel method for determining cardiac and volume status using waveforms from a standard peripheral intravenous (IV) line. We hypothesize that PIVA will demonstrate the onset of return of spontaneous circulation (ROSC) without interruption of CPR. Methods: Eight Zucker Diabetic Fatty (ZDF) rats (4 lean, 4 diabetic) were intubated, ventilated, and cannulated with a 24g IV in the tail vein and a 22g IV in the femoral artery, each connected to a TruWave pressure transducer. Mechanical ventilation was discontinued to achieve CA. After 8 minutes, CPR began with mechanical ventilation, IV epinephrine, and chest compressions using 1.5 cm at 200 times per minute until mean arterial pressure (MAP) increased to 120 mmHg per arterial line. All waveforms were recorded and analyzed in LabChart. PIVA was measured using a Fourier transform of the peripheral venous waveform. Data are mean ± SD. Statistics: Unpaired student’s t-test (two-tailed), α = 05. Results: CA and ROSC were achieved in all 8 rats. Within 1 minute of CPR, there was a 70 ± 35 fold increase/decrease in PIVA during CPR that was temporally associated with ROSC. Within 8 ± 13 seconds of a reduction in PIVA, there was a rapid increase in end-tidal CO 2 . In all rats, ROSC occurred within 38 ± 9 seconds of the maximum PIVA value. Peripheral venous pressure decreased by 1.2 ± 0.9 mmHg during resuscitation and ROSC, which was not significant different at p=0.05. Conclusion: In this pilot study, PIVA detected ROSC without interrupting CPR. Use of PIVA may obviate the need pause CPR for pulse checks, and may result in a higher CCF and survival. Future studies will focus on PIVA and CPR efficacy.

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