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Chest wall recoil

Question Type:
Intervention
Full Question:
Among adults and children who are in cardiac arrest in any setting (P), does maximizing chest wall recoil (I), compared with ignoring chest wall recoil (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, coronary perfusion pressure, cardiac output (O)?
Consensus on Science:
​For the critical outcomes of ROSC, survival at hospital discharge, and survival with favorable neurologic/functional outcome, we found no evidence to address the question. For the important outcome of coronary perfusion pressure, we found 3 observational studies: 2 in animal models(Yannopoulos 2005, 363; Zuercher 2010, 1141) and 1 in anesthetized children not in cardiac arrest,(Glatz 2013, 1674) which provided very-low-quality evidence, downgraded for serious risk of bias and very serious indirectness. All 3 studies reported a reduced coronary perfusion pressure with incomplete chest recoil. In anesthetized children undergoing mechanical ventilation during cardiac catheterization, Glatz et al analyzed the effect of leaning by applying a force on the chest corresponding to 10% and 20% of body weight; this resulted in a proportional reduction in coronary perfusion pressure.(Glatz 2013, 1674) Yannopoulos et al and Zuercher et al reported in swine models of VF that leaning on the chest precluding full chest recoil reduced the coronary perfusion pressure in a dose-dependent manner.(Yannopoulos 2005, 363; Zuercher 2010, 1141) For the important outcome of cardiac output/cardiac index, we found 2 observational studies (1 in an animal model and 1 in anesthetized children not in cardiac arrest) also representing very-low-quality evidence downgraded for serious risk of bias and very serious indirectness.(Zuercher 2010, 1141; Glatz 2013, 1674) The study in animals reported a proportional reduction in cardiac index when 10% and 20% of the forces applied during compression remained between compressions.(Zuercher 2010, 1141) In contrast, Glatz et al found that leaning forces had no effect on cardiac output.(Glatz 2013, 1674)
Treatment Recommendation:
We suggest that rescuers performing manual CPR avoid leaning on the chest between compressions to allow full chest wall recoil (weak recommendation, very-low-quality evidence). Values, Preferences, and Task Force Insights In making this recommendation, the task force placed high value on consistency with previous recommendations and in ensuring that a clear recommendation is provided for CPR training and practice. We acknowledge that some studies have reported a leaning threshold below which there are possibly no adverse hemodynamic effects, but the task force anticipates that this would be difficult to measure and teach.
CoSTR Attachments:
367 Chest recoil- summary 150328 final version.docx    
BLS 367 ILCOR 2015 Dallas ppt PDF.pdf    
Chest recoil- full information 141120 final version_1.docx    
Inclusion and Exclusion Criteria 3.28.15.docx    
Summary of Bias Assessments 141120.xlsx    

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