Skip Ribbon Commands
Skip to main content
SharePoint

PublicComment

 Feedback

If you have any comments or questions on this page, please email us at:
 

Chest compression rate

Question Type:
Intervention
Full Question:
Among adults and children who are in cardiac arrest in any setting (P), does any specific rate for external chest compressions (I), compared with a compression rate of about 100/min (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, CPR quality (O)?
Consensus on Science:
No studies addressed the critical outcome of favorable neurologic outcome.For the critical outcome of survival to hospital discharge, we identified very-low-quality evidence from 2 observational studies(Idris 2012, 3004; Idris 2015, 840) representing 13 469 adult patients. Both studies were downgraded due to risk of bias.(Idris 2015, 840) They compared chest compression rates of greater than 140/min, 120 to 139/min, less than 80/min, and 80 to 99/min with the control rate of 100 to 119/min. When compared with the control chest compression rate of 100 to 119/min, there was a • 4% decrease in survival to hospital discharge with compression rates of greater than 140/min• 2% decrease in survival to hospital discharge with compression rates of 120 to 139/min• 1% decrease in survival to hospital discharge with compression rates of less than 80/min • 2% decrease in survival to hospital discharge with compression rates of 80 to 99/min The study found a significant relationship between chest compression rate categories and survival without adjustment and when adjusted for covariates, including CPR quality measures such as compression depth and fraction (global test, P=0.02). The study showed chest compression depth declined with increasing chest compression rate. The relationship of reduced compression depth at different compression rates was as follows: for a compression rate of 100 to119/min, 35% of compressions had a depth less than 38 cm; for a compression rate of 120 to 139/min, 50% of compressions had a depth less than 38 cm; and for a compression rate of 140/min or greater, 70% of the compressions had a depth less than 38 cm.In the second study,(Idris 2012, 3004) there was a 4.1% decrease in survival to hospital discharge with chest compression rates of greater than 140/min and a 1.9% increase in survival to hospital discharge with rates of less than 80/min when compared with the control rate of 80 to 140/min. The adjusted ORs for survival to hospital discharge were 0.61 (P=0.18) for rates of greater than 140/min and 1.32 (P=0.42) for rates of less than 80/min and, therefore, showed no significant difference in survival to hospital discharge. For the critical outcome of ROSC, we identified very-low-quality evidence from 3 observational studies(Abella 2005, 428; Idris 2012, 3004; Idris 2015, 840) representing 13 566 adult patients. All studies were downgraded due to risk of bias. All studies had different interventions and different control chest compression rates: 100 to 119/min,(Idris 2015, 840) 80 to 140/min,(Idris 2012, 3004) and 80 to 119/min.(Abella 2005, 428) High Compression RatesThere was a significant decrease in ROSC with chest compression rates of greater than 140/min (OR, 0.72; P=0.006). However, significance was lost when the model was adjusted for covariates (gender, witnessed arrest, bystander CPR, first known EMS rhythm, location).(Idris 2015, 840) There was a 5% decrease in ROSC with rates of greater than 140/min,(Idris 2012, 3004) and 9% increase in ROSC with rates of greater than 120/min(Abella 2005, 428) when compared with their respective control chest compression rates. Low Compression RatesWith chest compression rates of less than 80/min, there was a 3% increase in ROSC in 1 study(Idris 2012, 3004) and 25% decrease in ROSC in other.(Abella 2005, 428) The adjusted ORs for ROSC were 1.01 (P=0.95) for rates of greater than 140/min(Idris 2012, 3004) and 1.18 (P=0.79) for rates of less than 80/min.(Idris 2012, 3004) Comparison of mean chest compression rates of 95.5 to 138.7/min with 40.3 to 72.0/min showed a +33% increase in ROSC (P=0.00925).(Abella 2005, 428) Comparison of mean chest compression rates of 87.1 to 94.8/min with 40.3 to 72.0/min showed a +33% increase in ROSC (P=0.00371).(Abella 2005, 428) For the important outcome of systolic blood pressure, we identified very-low-quality evidence from 1 observational study(Ornato 1988, 241) where a mechanical CPR device (Thumper, Michigan Instruments, MI) was used to deliver incremental increases in chest compressions (from 80 to 140/min) among 18 adult patients. Within subject comparisons showed increasing the compression rate reduced systolic blood pressure (to 74% of baseline at a rate of 140/min, P
Treatment Recommendation:
We recommend a manual chest compression rate of 100 to 120/min (strong recommendation, very-low-quality evidence). Values, Preferences, and Task Force Insights In making this recommendation, we place a high value on compatibility with the previous guidelines recommendation of a lower compression threshold of at least 100/min to minimize additional training and equipment costs (eg, reprogramming feedback devices, educational programs). We consider the new evidence that has emerged since 2010 CoSTR as sufficient to suggest that the upper threshold should be limited to no more than 120/min.
CoSTR Attachments:
2015_01_15 ILCOR CPR rate WS - Evidence tables - FINAL_n.docx    

 Contact Us

 
If you have any comments or questions on this page, please email us at: