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Starting CPR

Question Type:
Intervention
Full Question:
Among adults and children who are in cardiac arrest in any setting (P), does CPR beginning with compressions first (30:2) (I), compared with CPR beginning with ventilation first (2:30) (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:
There were no human studies identified in this evidence review, but 4 manikin studies were identified; 1 randomized study(Marsch 2013, w13856) focused on adult resuscitation, 1 randomized study focused on pediatric resuscitation,(Lubrano 2012, 1473) and 2 observational studies focused on adult resuscitation.(Kobayashi 2008, 333; Sekiguchi 2013, 1248) Compared with the previous review in 2010, this review also identified 3 new studies that were included for analysis.(Lubrano 2012, 1473; Marsch 2013, w13856; Sekiguchi 2013, 1248) Overall, the reviewers had serious concerns for trial methodology of included studies. The nature of comparing 2 different resuscitation protocols meant that all studies suffered from performance and detection bias because healthcare professionals were not blinded to the intervention (C-A-B versus A-B-C). For the important outcome of time to commencement of chest compressions, we identified very-low-quality evidence from 1 randomized manikin study(Lubrano 2012, 1473) representing 155 two-person teams and very-low-quality evidence from 2 observational manikin studies(Kobayashi 2008, 333; Sekiguchi 2013, 1248) representing 40 individual rescuers(Sekiguchi 2013, 1248) and 33 six-person teams.(Kobayashi 2008, 333) All studies were downgraded due to risk of bias. All studies found that C-A-B decreased the time to commencement of chest compression. The randomized trial found a statistically significant 24.13-second difference (P
Treatment Recommendation:
We suggest commencing CPR with compressions rather than ventilations (weak recommendation, very-low-quality evidence). Values, Preferences, and Task Force Insights In making this recommendation in the absence of human data, we placed a high value on time to specific elements of CPR (chest compressions, rescue breathing, completion of first CPR cycle). In making this recommendation in the absence of human data, given that most cardiac arrests in adults are cardiac in cause, we placed a high value on reducing time to specific elements of CPR (chest compressions and completion of first CPR cycle). We refer the reader to the systematic review Peds 709 (see “Part 6: Pediatric Basic Life Support and Pediatric Advanced Life Support”) for recommendations in children.
CoSTR Attachments:
2015_01_01 ILCOR CPR start WS - PREFINAL.doc    

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