Chest compression rate (BLS): Scoping Review

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This Review is a draft version prepared by ILCOR, with the purpose to allow the public to comment and is labeled “Draft for Public Comment". The comments will be considered by ILCOR. The next version will be labelled “draft" to comply with copyright rules of journals. The final Review will be published on this website once a summary article has been published in a scientific Journal and labeled as “final”.

Conflict of Interest Declaration

The ILCOR Continuous Evidence Evaluation process is guided by a rigorous ILCOR Conflict of Interest policy. The following Task Force members and other authors were recused from the discussion as they declared a conflict of interest: (none applicable)

The following Task Force members and other authors declared an intellectual conflict of interest and this was acknowledged and managed by the Task Force Chairs and Conflict of Interest committees: (none applicable)

Task Force Scoping Review Citation

Considine J, Gazmuri RJ, Perkins GD, Kudenchuk PJ, Olasveengen TM, Vaillancourt C, Nishiyama C, Hatanaka T, Mancini ME, Chung SP, Escalante-Kanashiro R, Morley - on behalf of the International Liaison Committee on Resuscitation Basic Life Support Task Force. Compression rate in Cardiac Arrest in Adults Scoping Review and Task Force Insights [Internet] Brussels, Belgium: International Liaison Committee on Resuscitation (ILCOR) Basic Life Support Task Force, 2019 June. Available from: http://ilcor.org 5 January 2020

Methodological Preamble and Link to Published Scoping Review

The continuous evidence evaluation process started with a scoping review of basic life support conducted by the ILCOR BLS Task Force Scoping Review team. Evidence for adult literature was sought and considered by the Basic Life Support Adult Task.

Scoping Review

Webmaster to insert the Scoping Review citation and link to Pubmed using this format when/if it is available.

Considine J, Gazmuri RJ, Perkins GD, Kudenchuk PJ, Olasveengen TM, Vaillancourt C, Nishiyama C, Hatanaka T, Mancini ME, Chung SP, Escalante-Kanashiro R, Morley P. Chest compression components (rate, depth, chest wall recoil and leaning): A scoping review. Resuscitation. 2019 Sep 16. pii: S0300-9572(19)30608-2. PMID: 31536776

doi:10.1016/j.resuscitation.2019.08.042.

PICOST

The PICOST (Population, Intervention, Comparator, Outcome, Study Designs and Timeframe)

Population: Adults in any setting (in-hospital or out-of-hospital) with (cardiac arrest)

Intervention: Different chest compression rate, depth and incomplete chest wall recoil during CPR,

Comparators: Standard chest compression rate, depth and incomplete chest wall recoil during CPR

Outcomes: Survival to hospital discharge with good neurological outcome and survival to hospital discharge were ranked as critical outcomes. Return of spontaneous circulation (ROSC) and physiological measures (e.g., blood pressure and end-tidal PCO2) were ranked as a important outcomes.

Study Designs: Randomized controlled trials (RCTs) and non-randomized studies (non-randomized controlled trials, interrupted time series, controlled before-and-after studies, cohort studies) are eligible for inclusion.

Timeframe: All years and all languages were included as long as there was an English abstract; unpublished studies (e.g., conference abstracts, trial protocols) were excluded. Literature search updated to June, 2019.

Search Strategies

Complete search strategies may be found in the published scoping review.(Considine 2019)

Inclusion and Exclusion criteria

The inclusion/exclusion criteria used in this scoping review were different to those used in the 2015 CoSTR: the 2015 CoSTR included animal studies and in the 2015 CoSTR chest compression components were treated as separate entities and there was no requirement that two or more CC rates, depths, measures of recoil or leaning be compared.

Studies were considered eligible for inclusion if they were peer-reviewed human studies that prospectively or retrospectively compared the effects of interventions listed below on physiological (e.g., blood pressure and end-tidal PCO2) or clinical outcomes (e.g., return of spontaneous circulation (ROSC) and survival to a defined time point):

- two or more CC depths measured in millimetres, centimetres, or inches OR

- two or more CC rates measured in compressions per minute OR - two or more measures of chest wall recoil OR

- two or more measures of leaning or leaning versus no leaning.

Full chest wall recoil is defined as the sternum returning to a neutral position during the decompression phase of CPR. Chest wall leaning is when the rescuer fails to completely release pressure on the chest wall between compressions, preventing full chest wall recoil.

Unpublished studies or studies published in abstract form only, manikin studies, animal studies, and studies that did not specifically address the PICO questions related to CC rate, CC depth, chest wall recoil, and leaning were excluded.

Data tables

Complete set for tables may be found in the published scoping review.(Considine 2019)

Task Force Insights

1. Why this topic was reviewed.

In November 2018, at the ILCOR meeting in Chicago, the BLS Task Force decided to reactivate the PICOs related to chest compression rate, chest compression depth, and chest wall recoil, acknowledging that further work was required to understand whether there was new science published to date that provided more information on these chest compression components as discrete entities or whether studies have reported interactions between these CC components. Therefore, a scoping review was undertaken to: i) understand whether the science to date has focused on single chest compression components or interactions between chest compression components and ii) to identify the evidence related to the chest compression components to determine whether the body of evidence published since the 2015 BLS CoSTR indicates the need for a full systematic review of the evidence related to chest compression components.

2. Narrative summary of evidence identified

In addition to the 14 studies identified in 2015 CoSTR, an additional 8 studies (Cheskes 2015 38; Hwang 2016 1491; Kilgannon 2017 154; Kovacs 2015 107; Riyapan 2019 245; Sainio 2015 163

Sutton 2015 150; Sutton 2018 159) were identified so a total of 22 studies were included in this scoping review. Five observational studies examined both chest compression rate and chest compression depth.(Sainio 2015 163; Sutton 2015 150; Edelson 2006 137; Kramer-Johansen 2006 283; Riyapan 2019 245) One randomised controlled trial (RCT),(Hwang 2016 1491) 1 crossover trial (Kern 1992 145) and 6 observational studies examined chest compression rate only.(Sutton 2018 159; Kilgannon 2017 154; Idris 2015 840; Idris 2012 3003; Abella 2005 428; Ornato 1988 241) 1 RCT(Bohn 2011 257) and 6 observational studies examined chest compression depth only;(Stiell 2014 1962; Sutton 2010 1179; Vadeboncoeur 2014 182; Hellevuo 2013 760; Stiell 2012 1192; Babbs 2008 306) and 2 observational studies examined chest wall recoil.(Cheskes 2015 38; Kovacs 2015 107) No studies were identified that examined different measures of leaning.

3. Narrative Reporting of the task force discussions

This scoping review demonstrated that the majority of studies focused on a single chest compression component, whereas a number of studies suggest the presence of confounding interactions that prompt caution when evaluating any chest compression component in isolation.

The majority of the studies identified in this review were focused on out-of-hospital cardiac arrest highlighting a major gap in research in the in-hospital context.

This scoping review has not identified sufficient new evidence to prompt new systematic review.

The information from the studies identified was considered insufficient to alter existing recommendations.

Knowledge Gaps

We identified a number of gaps in the published literature: lack of high-level evidence related to chest compression components, a lack of studies of in-hospital cardiac arrest, and failure to account for the possibility of conflicting interactions between chest compression components were considers the most important gaps.

References

Abella BS, Sandbo N, Vassilatos P, et al. Chest Compression Rates During Cardiopulmonary Resuscitation Are Suboptimal A Prospective Study During In-Hospital Cardiac Arrest. Circulation 2005;111:428-434.

Babbs CF, Kemeny AE, Quan W, Freeman G. A new paradigm for human resuscitation research using intelligent devices. Resuscitation 2008;77:306-315.

Bohn A, Weber TP, Wecker S, et al. The addition of voice prompts to audiovisual feedback and debriefing does not modify CPR quality or outcomes in out of hospital cardiac arrest – A prospective, randomized trial. Resuscitation 2011;82:257-262.

Cheskes S, Common MR, Byers AP, Zhan C, Silver A, Morrison LJ. The association between chest compression release velocity and outcomes from out-of-hospital cardiac arrest. Resuscitation 2015;86:38-43.

Considine J, Gazmuri RJ, Perkins GD, Kudenchuk PJ, Olasveengen TM, Vaillancourt C, Nishiyama C, Hatanaka T, Mancini ME, Chung SP, Escalante-Kanashiro R, Morley P. Chest compression components (rate, depth, chest wall recoil and leaning): A scoping review. Resuscitation. 2019. pii: S0300-9572(19)30608-2. PMID: 31536776 doi:10.1016/j.resuscitation.2019.08.042.

Edelson DP, Abella BS, Kramer-Johansen J, et al. Effects of compression depth and pre-shock pauses predict defibrillation failure during cardiac arrest. Resuscitation 2006;71:137-145.

Hellevuo H, Sainio M, Nevalainen R, et al. Deeper chest compression – More complications for cardiac arrest patients? Resuscitation 2013;84:760-765.

Hwang SO, Cha K-C, Kim K, et al. A Randomized Controlled Trial of Compression Rates during Cardiopulmonary Resuscitation. J Korean Med Sci 2016;31:1491-1498.

Idris AH, Guffey D, Aufderheide TP, et al. The relationship between chest compression rates and outcomes from cardiac arrest. Circulation 2012;125:3004-3012.

Idris AH, Guffey D, Pepe PP, et al. Chest Compression Rates and Survival Following Out-of-Hospital Cardiac Arrest. Crit Care Med 2015;43:840-848.

Kern KB, Sanders AB, Raife J, Milander MM, Otto CW, Ewy GA. A Study of Chest Compression Rates During Cardiopulmonary Resuscitation in Humans: The Importance of Rate-Directed Chest Compressions. Arch Int Med 1992;152:145-149.

Kilgannon JH, Kirchhoff M, Pierce L, Aunchman N, Trzeciak S, Roberts BW. Association between chest compression rates and clinical outcomes following in-hospital cardiac arrest at an academic tertiary hospital. Resuscitation 2017;110:154-161.

Kovacs A, Vadeboncoeur TF, Stolz U, et al. Chest compression release velocity: Association with survival and favorable neurologic outcome after out-of-hospital cardiac arrest. Resuscitation 2015;92:107-114.

Kramer-Johansen J, Myklebust H, Wik L, et al. Quality of out-of-hospital cardiopulmonary resuscitation with real time automated feedback: A prospective interventional study. Resuscitation 2006;71:283-292.

Ornato JP, Gonzalez ER, Garnett AR, Levine RL, McClung BK. Effect of cardiopulmonary resuscitation compression rate on end-tidal carbon dioxide concentration and arterial pressure in man. Crit Care Med 1988;16:241-245.

Riyapan S, Naulnark T, Ruangsomboon O, et al. Improving quality of chest compression in thai emergency department by using real-time audio-visual feedback cardio-pulmonary resuscitation monitoring. 2019;102:245-251.

Sainio M, Hoppu S, Huhtala H, Eilevstjønn J, Olkkola KT, Tenhunen J. Simultaneous beat-to-beat assessment of arterial blood pressure and quality of cardiopulmonary resuscitation in out-of-hospital and in-hospital settings. Resuscitation 2015;96:163-169.

Stiell IG, Brown SP, Christenson J, et al. What is the role of chest compression depth during out-of-hospital cardiac arrest resuscitation? Crit Care Med 2012;40:1192-1198.

Stiell IG, Brown SP, Nichol G, et al. What is the optimal chest compression depth during out-of-hospital cardiac arrest resuscitation of adult patients? 2014;130:1962-1970.

Sutton RM, Case E, Brown SP, et al. A quantitative analysis of out-of-hospital pediatric and adolescent resuscitation quality--A report from the ROC epistry-cardiac arrest. Resuscitation 2015;93:150-157.

Sutton RM, French B, Niles DE, et al. 2010 American Heart Association recommended compression depths during pediatric in-hospital resuscitations are associated with survival. Resuscitation 2014;85:1179-1184.

Sutton RM, Reeder RW, Landis W, et al. Chest compression rates and pediatric in-hospital cardiac arrest survival outcomes. Resuscitation 2018;130:159-166.

Vadeboncoeur T, Stolz U, Panchal A, et al. Chest compression depth and survival in out-of-hospital cardiac arrest. Resuscitation 2014;85:182-188.


CPR
compression, rate

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