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Hand position during compressions

Question Type:
Intervention
Full Question:
Among adults and children who are receiving chest compressions in any setting (P), does delivery of chest compressions on the lower half of the sternum (I), compared with any other location for chest compressions (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, cardiac output, harm (eg rib fracture), coronary perfusion pressure (O)?
Consensus on Science:
​There were no studies reporting the critical outcomes of favorable neurologic outcome, survival, or ROSC. For the important outcome of physiologic end points, we identified 3 very-low-quality studies (downgraded for bias, indirectness, and imprecision).(Orlowski 1986, 667; Cha 2013, 691; Qvigstad 2013, 1203) One crossover study in 17 adults with prolonged resuscitation from nontraumatic cardiac arrest observed improved peak arterial pressure during compression systole (114 ± 51 mm Hg versus 95 ± 42 mm Hg) and end-tidal carbon dioxide (ETCO2; 11.0 ± 6.7 mm Hg versus 9.6 ± 6.9 mm Hg) when compressions were performed in the lower third of the sternum compared with the center of the chest, whereas arterial pressure during compression recoil peak right atrial pressure and coronary perfusion pressure did not differ.(Cha 2013, 691) A second crossover study in 30 adults observed no difference between ETCO2 values and hand placement.(Qvigstad 2013, 1203) A further crossover study in 10 children observed higher peak systolic pressure and higher mean arterial blood pressure when compressions were performed on the lower third of the sternum compared with the middle of the sternum.(Orlowski 1986, 667)
Treatment Recommendation:
We suggest performing chest compressions on the lower half of the sternum on adults in cardiac arrest (weak recommendation, very-low-quality evidence). Values, Preferences, and Task Force Insights In making this recommendation, we place a high value on consistency with current treatment recommendations in the absence of compelling data suggesting the need to change the recommended approach.
CoSTR Attachments:
BLS 357 Copy of Summary of Bias Assessments Example and Template-SP.xlsx    
BLS 357 GRADE Table 1 - HP_2015-03-23.docx    
Recommendations - HP_2014-07-10.docx    

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