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 depth

Question Type:
Intervention
Full Question:
Among adults who are in cardiac arrest in any setting (P), does a different chest compression depth during CPR (I), compared with chest compression depth to 5 cm (2 inches) (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, coronary perfusion pressure, cardiac output, bystander CPR performance (O)?
Consensus on Science:
For the critical outcome of survival with good neurologic outcome, we found very-low-quality evidence (downgraded for serious bias, imprecision, and indirectness) from 2 observational studies(Hostler 2011, d512; Vadeboncoeur 2014, 182) suggesting that a compression depth in adults of more than 5 cm (2 inches) is better than all other compression depths during manual CPR. Adjusted OR for improved neurologic outcome for patients receiving chest compressions with a depth of 5.1 cm or more was 1.21 (95% CI, 1.00–1.46) (N=593, 175 missing data, which were imputed).(Vadeboncoeur 2014, 182)For the critical outcome of survival to hospital discharge, we found moderate-quality evidence (upgraded for a dose-response relationship, no serious bias in the 2 largest studies) from 4 observational studies(Hostler 2011, d512; Stiell 2012, 1192; Stiell 2014, 1962; Vadeboncoeur 2014, 182) suggesting that a compression depth range of 4.5 to 5.5 cm (1.8 to 2.2 inches) in adults is better than all other compression depths during manual CPR. Optimal depth ranges from adjusted cubic spline based on 9136 patients was 4.0 to 5.5 cm, with a peak at 4.6 cm.(Stiell 2014, 1962)For the critical outcome of ROSC, we found moderate-quality evidence (upgraded for a dose-response relationship, no serious bias in the 2 largest studies) from 8 observational studies(Edelson 2006, 137; Kramer-Johansen 2006, 283; Babbs 2008, 306; Edelson 2008, 1063; Bohn 2011, 257; Hostler 2011, d512; Stiell 2012, 1192; Stiell 2014, 1962) suggesting that a compression depth of more than 5 cm (2 inches) (range, 4.5–5.5 cm [1.8–2.2 inches]) in adults is better than all other compression depths during manual CPR. The adjusted OR for ROSC for patients receiving chest compressions with a depth of 3.8 to 5.1 cm (1.5 to 2 inches) compared with more than 5.1 cm (more than 2 inches) was 0.86 (95% CI, 0.75–0.97).(Stiell 2014, 1962) For the important outcome of injury, we found very-low-quality evidence (downgraded for serious risk of bias, imprecision, and very serious indirectness) from 1 observational study suggesting that a compression depth of more than 6 cm (2.4 inches) is associated with an increased rate of injury in adults when compared with compression depths of 5 to 6 cm (2 to 2.4 inches) during manual CPR. This study included 170 of 353 patients (183 excluded for incomplete data), and injuries were reported in 63% with compression depth more than 6 cm (more than 2.4 inches) and 31% with compression depth less than 6 cm. Further, injuries were reported in 28%, 27%, and 49% with compression depths less than 5 cm (less than 2 inches), 5 to 6 cm (2 to 2.4 inches), and more than 6 cm (more than 2.4 inches), respectively.(Hellevuo 2013, 760)
Treatment Recommendation:
We recommend a chest compression depth of approximately 5 cm (2 inches) (strong recommendation, low-quality evidence) while avoiding excessive chest compression depths (greater than 6 cm [greater than 2.4 inches] in an average adult) (weak recommendation, low-quality evidence) during manual CPR.Values, Preferences, and Task Force Insights In making this recommendation, we place a high value on the consistency with our previous recommendations given the resource implications (eg, training, reprogramming CPR devices) of making a change, and consistency in data showing harm from compressions that are too shallow. In addition, we note new data from the US and Canadian Resuscitation Outcomes Consortium group reporting a “sweet spot” for compression depth between 4.03 and 5.53 cm (between 1.59 and 2.2 inches; peak, 4.56 cm [1.8 inches]) and harm from excessive compression depths.(Stiell 2014, 1962) We used the term approximately 5 cm (approximately 2 inches) to reflect these findings plus the known variation in patient shapes and sizes around the world.We refer the reader to Ped 394 systematic review (see “Part 6: Pediatric Basic Life Support and Pediatric Advanced Life Support”) for recommendations in children.
CoSTR Attachments:
Grade table depth_n.docx    

 Contact Us

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