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Monitoring Physiological Parameters During CPR

Question Type:
Intervention
Full Question:
Among adults who are in cardiac arrest in any setting (P), does does the use of physiological feedback regarding CPR quality (eg, arterial lines, ETCO2 monitoring, SpO2 waveforms, or others)  (I), compared with compared with no feedback  (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 (O)?
Consensus on Science:
We found no studies that addressed the critical and important outcomes. For the outcome of change in physiologic values by modifications in CPR, we identified 13 observational studies that provided very-low-quality evidence (downgraded for serious risk of bias, serious inconsistency, serious indirectness, and serious imprecision) comparing different CPR techniques (standard, lower sternal, active compression-decompression, intra-abdominal compression, mechanical thumper, ITD, band chest compression, load-distributing band, vest CPR) with the use of physiologic monitoring (arterial line, ETCO2, oxygen saturation as measured by pulse oximetry (SpO2), coronary perfusion pressure, cerebral oximetry, near-infrared spectroscopy) in 469 subjects.(Berryman 1984, 226; Ward 1989, 831; Kern 1992, 145; Halperin 1993, 762; Ward 1993, 669; Orliaguet 1995, 48; Plaisance 2000, 989; Timerman 2004, 273; Axelsson 2009, 1099; Duchateau 2010, 1256; Cha 2013, 691; Manning 2013, S173; Segal 2013, 450) Differences were detected between different CPR techniques, although this was not consistent across different modalities. Given the heterogeneity of CPR techniques used across studies, data could not be pooled. There were no studies that were found that used physiologic feedback to evaluate CPR quality.
Treatment Recommendation:
We make no treatment recommendation for any particular physiological measure to guide CPR, because the available evidence would make any estimate of effect speculative. Values, Preferences, and Task Force Insights In making no recommendation, we have placed high value on the lack of evidence and the need for further studies in this area.
CoSTR Attachments:
Bias Assessment Physiological monitoring.xlsx    
SOF Table Physiological monitoring.pdf    

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