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Chest compression only CPR vs conventional CPR

Question Type:
Intervention
Full Question:
Among adults who are in cardiac arrest outside of a hospital (P), does provision of chest compressions (without ventilation) by untrained/trained laypersons (I), compared with chest compressions with ventilation  (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, bystander CPR performance, CPR quality (O)?
Consensus on Science:
For the critical outcome of survival with favorable neurologic outcome at 12 months, we identified very-low-quality evidence (downgraded for risk of bias, indirectness, and imprecision) from a single observational study of 1327 adult cardiac arrest victims of a presumed cardiac cause. The study reported no overall difference between compression-only and conventional CPR (OR, 0.98; 95% CI, 0.54–1.77).(Iwami 2007, 2900) For the critical outcome of survival with favorable neurologic outcome at 30 days, we identified very-low-quality evidence (downgraded for risk of bias and indirectness) from 4 observational studies that enrolled 40 646 patients.(SOS-KANTO Study Group 2007, 920; Ong 2008, 119; Kitamura 2010, 293; Kitamura 2011, 3) These studies reported no overall difference in outcomes. For the critical outcome of survival with favorable neurologic outcome at discharge, we identified very-low-quality evidence (downgraded for risk of bias, inconsistency, and indirectness) from 1 randomized trial(Rea 2010, 423) and 3 observational studies.(Olasveengen 2008, 914; Bobrow 2010, 1447; Panchal 2013, 435) The randomized trial enrolled 1268 patients and reported no difference in outcomes (OR, 1.25; 95% CI, 0.94–1.66). The observational studies enrolled 2195 patients and also found no overall differences between compression-only and conventional CPR. For the critical outcome of survival at 30 days, we identified very-low-quality evidence (downgraded for risk of bias and indirectness) from 1 randomized trial(Svensson 2010, 434) and 2 observational studies.(Holmberg 2001, 511; Bohm 2007, 2908) The randomized trial enrolled 1276 patients and found no difference in outcomes (OR, 1.24; 95% CI, 0.85–1.81).(Svensson 2010, 434) The observational studies enrolled 11 444 patients, and 2 found no overall difference between compression-only and conventional CPR.(Holmberg 2001, 511; Bohm 2007, 2908) For the critical outcome of survival at 14 days, we identified very-low-quality evidence (downgraded for risk of bias and indirectness) from 1 observational study(Bossaert 1989, S99) enrolling 829 patients, which found no difference between compression-only and conventional CPR (OR, 0.76; 95% CI, 0.46–1.24). For the critical outcome of survival to discharge, we identified very-low-quality evidence (downgraded for risk of bias, inconsistency, and indirectness) from 1 randomized trial(Hallstrom 2000, 1546) and 2 observational studies.(Gallagher 1995, 1922; Mohler 2011, 822) The randomized trial enrolled 520 patients and found no difference in outcomes (OR, 1.4; 95% CI, 0.88–2.22).(Hallstrom 2000, 1546) The observational studied enrolled 2486 patients and reported no difference between compression-only and conventional CPR.
Treatment Recommendation:
We recommend that chest compressions should be performed for all patients in cardiac arrest (strong recommendation, very-low-quality evidence). We suggest that those who are trained and willing to give rescue breaths do so for all adult patients in cardiac arrest (weak recommendation, very-low-quality evidence). Values, Preferences, and Task Force Insights In making these recommendations, the task force strongly endorsed the 2010 ILCOR Consensus on Science that all rescuers should perform chest compressions for all patients in cardiac arrest.(Koster 2010, e48; Sayre 2010, S298) We also highlight the 2015 dispatcher CPR recommendation that “dispatchers should provide chest compression–only CPR instructions to callers for adults with suspected OHCA.” The task force draws attention to the potential gains from the simplicity of teaching compression-only CPR. The task force further acknowledges the potential additional benefits of conventional CPR when delivered by trained laypersons, particularly in settings where EMS response intervals are long and for asphyxial causes of cardiac arrest. We refer the reader to Ped 414 systematic review (see “Part 6: Pediatric Basic Life Support and Pediatric Advanced Life Support”) for recommendations in children.
CoSTR Attachments:
2014 12 10 BLS 372 Berg Travers Lit Search_n.xlsx    
BLS 372 1.0 Final Bias Assessments 20150114.pdf    
BLS 372 2.3 Evidence Profile Table 20150120.pdf    

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