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Compression ventilation ratio

Question Type:
Intervention
Full Question:
Among adults and children who are in cardiac arrest in any setting (P), does delivery of CPR with another specific C:V ratio (I), compared with CPR using a 30:2 compression:ventilation ratio (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, hands-off time (O)?
Consensus on Science:
For the critical outcome of survival with favorable neurologic outcome at discharge, we found very-low-quality evidence from 2 observational studies(Olasveengen 2009, 407; Hinchey 2010, 348) that were downgraded for risk of bias and indirectness. Of the 1711 patients included, those who were treated under the 2005 guidelines with a compression-ventilation ratio of 30:2 had slightly higher survival than those patients treated under the 2000 guidelines with a compression-ventilation ratio of 15:2 (8.9% versus 6.5%). For the critical outcome of survival to hospital discharge, we identified very-low-quality evidence from 4 observational studies.(Steinmetz 2008, 908; Olasveengen 2009, 407; Sayre 2009, 469; Hinchey 2010, 348) The level of evidence was downgraded for risk of bias and indirectness. Of the 4183 patients included, those who were treated under the 2005 guidelines with a compression-ventilation ratio of 30:2 had slightly higher survival than those patients treated under the 2000 guidelines with a compression-ventilation ratio of 15:2 (11.0% versus 7.0%). For the critical outcome of survival to 30 days, we identified very-low-quality evidence from 1 observational study(Steinmetz 2008, 908) that was downgraded for risk of bias and indirectness. Patients treated under the 2005 guidelines had slightly higher survival than those patients treated under the 2000 guidelines (16.0% versus 8.3%). For the critical outcome of any ROSC, we identified very-low-quality evidence from 2 observational studies.(Olasveengen 2009, 407; Hinchey 2010, 348) The studies were downgraded for risk of bias and indirectness. Patients treated under the 2005 guidelines had a ROSC more often than those patients treated under the 2000 guidelines (38.7% versus 30.0%). For the critical outcome of ROSC at hospital admission, we identified very-low-quality evidence from 2 observational studies.(Steinmetz 2008, 908; Olasveengen 2009, 407) The studies were downgraded for risk of bias and indirectness. Of the 1708 patients included, those treated under the 2005 guidelines had ROSC at hospital admission more often than those patients treated under the 2000 guidelines (34.5% versus 17.1%). For the important outcome of hands-off time, we identified very-low-quality evidence from 2 observational studies(Olasveengen 2009, 407; Sayre 2009, 469) that were downgraded for risk of bias and indirectness. Patients who were treated with the use of the 2005 guidelines had less hands-off time than those patients treated under the 2000 guidelines.
Treatment Recommendation:
We suggest a compression-ventilation ratio of 30:2 compared with any other compression-ventilation ratio in patients in cardiac arrest (weak recommendation, low-quality evidence). Values, Preferences, and Task Force Insights In making this recommendation, we placed a high priority on consistency with our 2005 and 2010 treatment recommendations and the findings identified in this review, which suggest that the bundle of care (which included changing to a compression to ventilation ratio of 30:2 from 15:2) resulted in more lives being saved. We note that there would likely be substantial resource implications (eg, reprogramming, retraining) associated with a change in recommendation, and an absence of any data addressing our critical outcomes to suggest our current recommendation should be changed.
CoSTR Attachments:
BLS 362 Bias Assessment 20151007.xls    
BLS 362 GRADE Profile 20151007.docx    

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