Abstract
Background
Cardiopulmonary resuscitation (CPR) improves cardiac arrest survival. Cough CPR, percussion
pacing and precordial thump have been reported as alternative CPR techniques. We aimed
to summarise in a systematic review the effectiveness of these alternative CPR techniques.
Methods
We searched Ovid MEDLINE, EMBASE and the Cochrane Library on 24/08/2020. We included
randomised controlled trials, observational studies and case series with five or more
patients. Two reviewers independently reviewed title and abstracts to identify studies
for full-text review, and reviewed bibliographies and ‘related articles’ (using PubMed)
of full-texts for further eligible studies. We extracted data and performed risk-of-bias
assessments on studies included in the systematic review. We summarised data in a
narrative synthesis, and used GRADE to assess evidence certainty.
Results
We included 23 studies (cough CPR n = 4, percussion pacing n = 4, precordial thump
n = 16; one study studied two interventions). Only two (both precordial thump) had
a comparator group (‘standard’ CPR). For all techniques evidence certainty was very
low. Available evidence suggests that precordial thump does not improve survival to
hospital discharge in out-of-hospital cardiac arrest. The review did not find evidence
that cough CPR or percussion pacing improve clinical outcomes following cardiac arrest.
Conclusion
Cough CPR, percussion pacing and precordial thump should not be routinely used in
established cardiac arrest. In specific inpatient, monitored settings cough CPR (in
conscious patients) or percussion pacing may be attempted at the onset of a potential
lethal arrhythmia. These must not delay standard CPR efforts in those who lose cardiac
output.
PROSPERO registration number
CRD42019152925.
Keywords
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Article info
Publication history
Published online: February 11, 2021
Accepted:
January 20,
2021
Received in revised form:
December 14,
2020
Received:
September 12,
2020
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
