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Harm from CPR to victims not in cardiac arrest

Question Type:
Intervention
Full Question:
Among Adults and children who are NOT in cardiac arrest outside of a hospital (P), does provision of chest compressions from lay rescuers (I), compared with no use of chest compressions (C), change Survival with Favorable neurological/functional outcome at discharge, 30 days, 60 days, 180 days AND/OR 1 year, harm (eg rib fracture), complications, major bleeding, risk of complications (eg, aspiration), Survival only at discharge, 30 days, 60 days, 180 days AND/OR 1 year, survival to admission (O)?
Consensus on Science:
For the important outcome of “harm,” we identified very-low-quality evidence (downgraded for risk of bias and imprecision) from 4 observational studies enrolling 762 patients who were not in cardiac arrest and received CPR by lay rescuers outside the hospital.(White 2010, 91; Haley 2011, 282; Moriwaki 2012, 3; Tanaka 2014, 1751) Three of the studies(White 2010, 91; Haley 2011, 282; Moriwaki 2012, 3) reviewed the medical records to identify harm, and 1 included follow-up telephone interviews.(White 2010, 91) Pooled data from these 3 studies, encompassing 345 patients, found an incidence of bone fracture (ribs and clavicle) of 1.7% (95% CI, 0.4%–3.1%), pain in the area of chest compression of 8.7% (95% CI, 5.7%–11.7%), and no clinically relevant visceral injury. The fourth study(Tanaka 2014, 1751) relied on fire department observations at the scene, and there were no reported injuries in 417 patients.
Treatment Recommendation:
We recommend that laypersons initiate CPR for presumed cardiac arrest without concerns of harm to patients not in cardiac arrest (strong recommendation, very-low-quality evidence).Values, Preferences, and Task Force Insights In making this recommendation, we place a higher value on the survival benefit of CPR initiated by laypersons for patients in cardiac arrest against the low risk of injury in patients not in cardiac arrest.
CoSTR Attachments:
Copy of ILCOR_Data_Collection_(RJG)_n.xlsx    
GRADE Table (3 studies)_n.docx    

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