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Passive ventilation techniques

Question Type:
Intervention
Full Question:
Among adults and children who are in cardiac arrest in any setting (P), does addition of any passive ventilation technique (eg positioning the body, opening the airway, passive oxygen administration) to chest compression-only CPR (I), compared with just chest compression-only CPR (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 initiated CPR, oxygenation (O)?
Consensus on Science:
For the critical outcome of favorable neurologic outcome, we identified very-low-quality evidence (downgraded due to risk of serious bias and indirectness) from 1 retrospective study, which involved 1019 patients that showed no difference between passive (nonrebreather mask) and active (bag-mask) ventilation(Bobrow 2009, 656) (adjusted OR, 1.2; 95% CI, 0.8–1.9).For the critical outcome of survival, we found very-low-quality evidence from a single retrospective study (downgraded for serious indirectness and risk of bias).(Bobrow 2009, 656) This study reported no significant difference in survival (RR, 1.1; 95% CI, 0.72–1.54).For the critical outcome of ROSC, we found very-low-quality evidence (downgraded for serious indirectness and risk of bias) from 2 RCTs(Saissy 2000, 1523; Bertrand 2006, 843) and 1 observational study.(Bobrow 2009, 656) None of the studies showed any significant difference: OR, 0.88 (95% CI, 0.6–1.3)(Bertrand 2006, 843); OR, 0.8 (95% CI, 0.7–1.0)(Bobrow 2009, 656); and RR, 1.27 (95% CI, 0.6–2.61).(Saissy 2000, 1523)
Treatment Recommendation:
We suggest against the routine use of passive ventilation techniques during conventional CPR (weak recommendation, very-low-quality evidence).We suggest that where EMS systems have adopted bundles of care involving continuous chest compressions, the use of passive ventilation techniques may be considered as part of that bundle for patients in OHCA (weak recommendation, very-low-quality evidence).Values, Preferences, and Task Force Insights In making this recommendation, we place priority on consistency with our previous recommendations in the absence of compelling evidence for improvement in any of our critical outcomes. We acknowledge that where EMS systems have adopted a bundle of care that includes passive ventilation, it is reasonable to continue in the absence of compelling evidence to the contrary.
CoSTR Attachments:
GRADE_table_evidence_naloxone_n.docx    
GRADE_table_recommendation_naloxone_n.docx    
Summary Of Bias Assessment - BLS 891_n.xlsx    

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