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Chest Compression Depth

Question Type:
Intervention
Full Question:
In infants and children receiving chest compressions (in or out of hospital) (P), does does the use of any specific chest compression depth (I), compared with compared with the depth specified in the current treatment algorithm (C), change survival to 180 days with good neurological outcome, survival to hospital discharge, Complication Rate, Intermediate physiologic endpoints  (O)?
Consensus on Science:
For the critical outcomes of survival with good neurologic outcome and survival to hospital discharge, we identified very-low-quality evidence (downgraded for indirectness and imprecision) from 1 pediatric observational study of in-hospital cardiac arrest (IHCA)(Sutton 2014, 1179-1184) (89 cardiac arrest events) showing that chest compression depths of greater than 51 mm (greater than 5 cm [2 inches]) are associated with statistically significant improvement in outcomes (good neurologic outcome: RR, 3.71; 95% CI, 0.90–15.33; survival to discharge: RR, 3.48; 95% CI, 1.02–11.84).For the important outcomes of 24-hour survival and ROSC, we identified very-low-quality evidence (downgraded for indirectness and imprecision) from 1 pediatric observational study of IHCA(Sutton 2014, 1179-1184) enrolling 89 cardiac arrest events showing that events receiving chest compression of greater than 51 mm are associated with better survival to 24 hours (aOR, 10.3; 95% CI, 2.75–38.8; P
Treatment Recommendation:
We suggest that rescuers compress the chests of infants by at least one third the anterior-posterior dimension, or approximately 1½ inches (4 cm). We suggest that rescuers compress the child’s chest by at least one third of the anterior-posterior dimension, or approximately 2 inches (5 cm) (weak recommendation, very-low-quality evidence).Values, Preferences, and Task Force InsightsIn making these recommendations, we place a higher value on achieving adequate chest compression depth over the modest risk of exceeding recommended depths and potentially harming the patient. A recently published study of pediatric OHCA (released too late to be incorporated into the GRADE evaluation process) studied associations between chest compression depth and short-term outcomes (ie, ROSC).(Sutton 2015, Epub ahead of print) Despite the limited pediatric evidence linking chest compression depth to patient outcomes, recently published adult data(Idris 2015, 840-848) convincingly demonstrate improved clinical outcomes with the use of deeper chest compressions but also the potential for worsened patient outcomes with excessive chest compression depths.
CoSTR Attachments:
ILCOR 2015 Final Table 1 recommendations Chest Compression Depth Peds Worksheet Dec 2014_n.docx    
ILCOR final table two Chest Compression Depth Ped Worksheet Dec 2014_n.docx    
Should AHA compliant chest compression depths - 51mm vs chest compression depth - 50mm be used for (13) _n.docx    
Should any specific chest compression depth vs the depth specified in the current treatment algori (15)_n.docx    

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