Hands-only CPR is as effective as traditional CPR for cardiac arrest
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the evidence backs this
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the weight of evidence
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Peer-reviewed literature and systematic meta-analyses report that hands-only chest compression-only CPR and traditional CPR yield similar survival and neurological outcomes for out-of-hospital cardiac arrest.
<h4>Background</h4>In out-of-hospital cardiac arrest, dispatcher-assisted chest-compression-only bystander CPR might be superior to standard bystander CPR (chest compression plus rescue ventilation), but trial findings have not shown significantly improved outcomes. We aimed to establish the association of chest-compression-only CPR with survival in patients with out-of-hospital cardiac arrest.<h4>Methods</h4>Medline and Embase were systematically reviewed for studies published between January, 1985, and August, 2010, in which chest-compression-only bystander CPR was compared with standard bystander CPR for adult patients with out-of-hospital cardiac arrest. In the primary meta-analysis, we included trials in which patients were randomly allocated to receive one of the two CPR techniques, according to dispatcher instructions; and in the secondary meta-analysis, we included observational cohort studies of chest-compression-only CPR. All studies had to supply survival data. The primary outcome was survival to hospital discharge. A fixed-effects model was used for both meta-analyses because of an absence of heterogeneity among the studies (I(2)=0%).<h4>Findings</h4>In the primary meta-analysis, pooled data from three randomised trials showed that chest-compression-only CPR was associated with improved chance of survival compared with standard CPR (14% [211/1500] vs 12% [178/1531]; risk ratio 1·22, 95% CI 1·01-1·46). The absolute increase in survival was 2·4% (95% CI 0·1-4·9), and the number needed to treat was 41 (95% CI 20-1250). In the secondary meta-analysis of seven observational cohort studies, no difference was recorded between the two CPR techniques (8% [223/2731] vs 8% [863/11 152]; risk ratio 0·96, 95% CI 0·83-1·11).<h4>Interpretation</h4>For adults with out-of-hospital cardiac arrest, instructions to bystanders from emergency medical services dispatch should focus on chest-compression-only CPR.<h4>Funding</h4>US National Institutes of Health and American Heart Association.
<h4>Aim</h4>To compare the effectiveness of different compression-to-ventilation methods during cardiopulmonary resuscitation (CPR) in patients with cardiac arrest.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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 <1years of age, no statistically significant differences were observed.
<h4>Background</h4>According to the guidelines of cardiopulmonary resuscitation (CPR) conducted by bystanders, two methods of CPR are feasible: standard CPR (sCPR) with mouth-to-mouth ventilations and continuous chest compression-only CPR (CCC) without rescue breathing. The goal herein, was to evaluate the effect of sCPR (30:2) and CCC on resuscitation outcomes in patients with out-of-hospital cardiac arrest (OHCA) patients.<h4>Methods</h4>This study was a systematic review and meta-analysis. Using standardized criteria, Pub- Med, Web of Science, Scopus, EMBASE and Cochrane Collaboration were searched for trials assessing the effect of sCPR vs. CCC on resuscitation outcomes after adult OHCA. Random-effects model meta-analysis was applied to calculate the mean deviation (MD), odds ratio (OR) and 95% confidence interval (CI).<h4>Results</h4>Overall, 3 randomized controlled trials and 12 non-randomized trials met the inclusion criteria. Survival to hospital discharge with sCPR was 10.2% compared to 9.3% in the CCC group (OR = 1.04; 95% CI: 0.93-1.16; p = 0.46). Survival to hospital discharge with good neurological outcome measured with the cerebral performance category (CPC 1 or 2) was 6.5% for sCPR vs. 5.8% for CCC (OR = 1.00; 95% CI: 0.84-1.20; p = 0.98). Prehospital return of spontaneous circulation (ROSC) in sCPR and CCC groups was 15.9% and 14.8%, respectively (OR = 1.13; 95% CI: 0.91-1.39; p = 0.26). Survival to hospital admission with ROSC occurred in 29.5% of the sCPR group compared to 28.4% in CCC group (OR = 1.20; 95% CI: 0.89-1.63; p = 0.24).<h4>Conclusions</h4>This systematic review and meta-analysis concluded that there were no significant differences in the resuscitation outcomes between the use of standard cardiopulmonary resuscitation and chest compression only.
<h4>Background</h4>Evidence to support a better cardiopulmonary resuscitation method between standard vs. continuous chest compression (STD-CPR vs. CCC-CPR) is lacking.<h4>Materials and methods</h4>Our systematic review followed PRISMA guidelines. We searched PubMed, ScienceDirect, EBSCOhost, and ProQuest database from 1985 to 26 September 2019 restricted to randomized controlled trial, human study, and English articles. Quality assessment of between-study heterogeneity and a trial sequential analysis (TSA) were conducted. We estimated overall significance with 80% power and adjusted Z values thresholds using O'Brien-Fleming α‑spending function. Required information size with 21% relative risk using the estimation between-group incidences provided from the median rate across trials was determined. Inconclusive TSA result will lead to size estimation of future RCT. Quality of evidence was analyzed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) Handbook and TSA.<h4>Results</h4>Based on three trials in OHCA with dispatcher-guided and bystander-initiated CPR, our meta-analysis favors CCC-CPR for survival to hospital discharge, compared to STD-CPR (RR [Risk Ratio] = 1.21[1.01-1.46], 95% CI, p = 0.68, I<sup>2</sup> = 0). However, current meta-analyses with 3031 patients appeared to be inconclusive. There is a significant risk of type 1 error and therefore, results are potentially false positive. It is estimated that a minimal of 4331 patients needed to deem a conclusive result and a total of 5894 patients with similar risk profile required to stabilize statistic results in future trials. Quality of evidence is downgraded to moderate due to serious imprecision based on TSA.<h4>Conclusion</h4>Based on these analyses, evidence is inadequate to conclude the superiority of one CPR method over the other. Further trials with larger numbers of patients are needed to deem a conclusive and stable meta-analysis.
BACKGROUND
Out-of-hospital cardiac arrest (OHCA) has high mortality, and bystander cardiopulmonary resuscitation (CPR) improves outcomes. The comparative effectiveness of chest compression-only CPR (CCO) versus standard CPR (sCPR) with ventilation remains uncertain.
METHODS
We systematically searched PubMed, Scopus, Web of Science, Embase, Google Scholar, and Cochrane Library for randomized controlled trials (RCTs) and observational cohorts of adult OHCA comparing bystander CCO and sCPR. Primary outcomes were survival to hospital discharge and favourable neurological outcome; secondary outcomes were prehospital return of spontaneous circulation (ROSC), survival to hospital admission, 24-hour survival, and one-month mortality.
RESULTS
Eighteen studies (5 RCTs, 13 observational cohorts) including 232,655 OHCA cases (CCO n = 152,632; sCPR n = 80,023). Survival to hospital discharge was similar (OR 0.85; 95% CI 0.61-1.19). Favourable neurological outcome at discharge did not differ (OR 0.87; 95% CI 0.64-1.20). Prehospital ROSC (OR 1.06; 95% CI 0.89-1.27) and survival to admission (OR 1.12; 95% CI 0.79-1.49) were similar. For 24-hour mortality (OR 0.92; 95% CI 0.83-1.01), sensitivity analyses suggested lower survival with sCPR (OR 0.87-0.90). One-month mortality was similar overall (OR 1.26; 95% CI 0.98-1.62), but higher after CCO in sensitivity analyses (OR 1.32; 95% CI 1.02-1.71).
CONCLUSION
In adult OHCA, CCO and sCPR yield similar survival and neurological outcomes; CCO remains effective, simple strategy that may enhance bystander CPR delivery.
Abstract Background Out-of-hospital cardiac arrest (OHCA) has high mortality, and bystander cardiopulmonary resuscitation (CPR) improves outcomes. The effectiveness of chest compression-only CPR (CCO) versus standard CPR (sCPR) with ventilation remains unclear. This meta-analysis assesses their impact on survival, neurological recovery, and return of spontaneous circulation (ROSC). Methods A systematic review and meta-analysis followed PRISMA guidelines. PubMed, Scopus, Web of Science, Embase, Google Scholar, and Cochrane Library were searched. Eligible studies included RCTs and observational studies on adult OHCA. Pediatric and non-original studies were excluded. Primary outcomes were survival to hospital discharge (SHD) and neurological recovery, while secondary outcomes included ROSC, survival to hospital admission, and 24-hour and one-month survival. Study quality was assessed using ROB-2 for RCTs and the Newcastle-Ottawa Scale (NOS) for observational studies. A random-effects model was applied, and publication bias was evaluated. Results A total of 18 studies (5 RCTs, 13 observational) with 232,655 OHCA cases were analyzed. SHD rates showed no significant difference (OR = 0.85, 95% CI: 0.61–1.19, P = 0.29). Favorable neurological outcomes were similar (OR = 0.87, 95% CI: 0.64–1.20, P = 0.32). Prehospital ROSC rates were comparable (OR = 1.06, 95% CI: 0.89–1.27, P = 0.43). No difference was found in survival to hospital admission (OR = 1.12, 95% CI: 0.53– 2.29, P = 0.34). For 24-hour mortality, no difference was found (OR = 0.92, 95% CI: 0.83–1.01, P = 0.07), but sCPR had lower survival after sensitivity analysis (OR = 0.90, 95% CI: 0.82–1.00, P = 0.04). One-month mortality was similar (OR = 1.26, 95% CI: 0.98–1.62, P = 0.07), but sCPR had a higher risk after outlier removal (OR = 1.32, 95% CI: 1.02–1.71, P = 0.03). Hospital discharge rates showed no difference (OR = 0.79, 95% CI: 0.36–1.72, P = 0.55). SHD with favorable neurological outcomes did not differ significantly (OR = 1.47, 95% CI: 0.09–22.68, P = 0.61). Subgroup analyses indicated sCPR benefits in witnessed arrests and shockable rhythms. Conclusion No significant differences were found between CCO and sCPR in key survival outcomes. While sCPR may benefit specific subgroups, CCO remains an effective alternative that increases bystander participation. Further research is needed to refine guidelines
compression-only CPR is as effi- cacious as traditional CPR for the first few minutes of cardiac arrest. The … MANAGING THE AIRWAY IN CARDIAC ARREST? Certainly the priority in cardiac arrest is CPR with effective … best efforts, many patients in cardiac arrest stay in cardiac arrest. Though not as well validated as
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