Abstract
Aim
To compare the effectiveness of different compression-to-ventilation methods during
cardiopulmonary resuscitation (CPR) in patients with cardiac arrest.
Methods
We searched MEDLINE and Cochrane Central Register of Controlled Trials from inception
until January 2016. We included experimental, quasi-experimental, and observational
studies that compared different chest compression-to-ventilation ratios during CPR
for all patients and assessed at least one of the following outcomes: favourable neurological
outcomes, survival, return of spontaneous circulation (ROSC), and quality of life.
Two reviewers independently screened literature search results, abstracted data, and
appraised the risk of bias. Random-effects meta-analyses were conducted separately
for randomised and non-randomised studies, as well as study characteristics, such
as CPR provider.
Results
After screening 5703 titles and abstracts and 229 full-text articles, we included
41 studies, of which 13 were companion reports. For adults receiving bystander or
dispatcher-instructed CPR, no significant differences were observed across all comparisons
and outcomes. Significantly less adults receiving bystander-initiated or plus dispatcher-instructed
compression-only CPR experienced favourable neurological outcomes, survival, and ROSC
compared to CPR 30:2 (compression-to-ventilation) in un-adjusted analyses in a large
cohort study. Evidence from emergency medical service (EMS) CPR providers showed significantly
more adults receiving CPR 30:2 experiencing improved favourable neurological outcomes
and survival versus those receiving CPR 15:2. Significantly more children receiving
CPR 15:2 or 30:2 experienced favourable neurological outcomes, survival, and greater
ROSC compared to compression-only CPR. However, for children <1 years of age, no significant
differences were observed between CPR 15:2 or 30:2 and compression-only CPR.
Conclusions
Our results demonstrated that for adults, CPR 30:2 is associated with better survival
and favourable neurological outcomes when compared to CPR 15:2. For children, more
patients receiving CPR with either 15:2 or 30:2 compression-to ventilation ratio experienced
favourable neurological function, survival, and ROSC when compared to CO-CPR for children
of all ages, but for children <1 years of age, no statistically significant differences were observed.
Abbreviations:
CA (cardiac arrest), CC-CPR (continuous compression CPR), CI (confidence interval), CO-CPR (compression-only CPR), CPR (cardiopulmonary resuscitation), EMS (emergency medical service), EPOC (Effective Practice and Organization of Care), GRADE (Grading of Recommendation, Assessment, Development, and Evaluation), ILCOR BLS (International Liaison Committee on Resuscitation Basic Life Support), MICR (minimally-interrupted cardiac resuscitation), OHCA (out-of-hospital cardiac arrest), OR (odds ratio), PICOST (Population, Intervention, Control, Outcomes, Study design and Timeframe), PRESS (Peer Review of Electronic Search Strategies), PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols), RCTs (randomised controlled trials), RD (risk differences), ROSC (return of spontaneous circulation), RR (risk ratio), SD (standard deviation)Keywords
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Article info
Publication history
Published online: June 02, 2017
Accepted:
May 31,
2017
Received in revised form:
May 30,
2017
Received:
November 11,
2016
Identification
Copyright
© 2017 Elsevier B.V. All rights reserved.
