Compression-only cardiopulmonary resuscitation vs standard cardiopulmonary resuscitation: an updated meta-analysis of observational studies

Cardiopulmonary Resuscitation: The Importance of the Basics

Cardiac arrest is the loss of organized cardiac activity. Unfortunately, survival to hospital discharge is poor, despite recent scientific advances. The goals of cardiopulmonary resuscitation (CPR) are to restore circulation and identify and correct an underlying etiology. High-quality compressions remain the foundation of CPR, optimizing coronary and cerebral perfusion pressure. High-quality compressions must be performed at the appropriate rate and depth. Interruptions in compressions are detrimental to management. Mechanical compression devices are not associated with improved outcomes but can assist in several situations.

Readiness of Bystander Cardiopulmonary Resuscitation (BCPR) during the COVID-19 Pandemic: A Review

Early cardiopulmonary resuscitation (CPR) is a strong link in the of survival for sudden cardiac arrest. Hence, bystander CPR (BPCR) plays an important role in curbing mortality and morbidity from out-of-hospital sudden cardiac arrest. However, the recent global Coronavirus disease 2019 (COVID-19) pandemic has impacted both public training and confidence in performing out-of-hospital CPR. This paper reviews detailed information from databases including Google Scholar, Scopus, PubMed and Web of Science on the readiness of BCPR during the pandemic. We also discussed the challenges bystanders encountered during the COVID-19 pandemic and the precautions to follow. Finally, we also highlighted the limitations which would benefit future endeavours in establishing well-planned and sustainable CPR training programs for the public. Therefore, regardless of the existing COVID-19 pandemic, BCPR must be emphasised to curb out-of-hospital cardiac arrest (OHCA) mortality.

Current evidence of survival benefit between chest-compression only versus standard cardiopulmonary resuscitation in out-of-hospital cardiac arrest : Updated systematic review and meta-analysis of randomized controlled trials with trial sequential analysis

BACKGROUND

Evidence to support a better cardiopulmonary resuscitation method between standard vs. continuous chest compression (STD-CPR vs. CCC-CPR) is lacking.

MATERIALS AND METHODS

Our systematic review followed PRISMA guidelines. We searched PubMed, ScienceDirect, EBSCOhost, and ProQuest database from 1985 to 26 September 2019 restricted to randomized controlled trial, human study, and English articles. Quality assessment of between-study heterogeneity and a trial sequential analysis (TSA) were conducted. We estimated overall significance with 80% power and adjusted Z values thresholds using O'Brien-Fleming α‑spending function. Required information size with 21% relative risk using the estimation between-group incidences provided from the median rate across trials was determined. Inconclusive TSA result will lead to size estimation of future RCT. Quality of evidence was analyzed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) Handbook and TSA.

RESULTS

Based on three trials in OHCA with dispatcher-guided and bystander-initiated CPR, our meta-analysis favors CCC-CPR for survival to hospital discharge, compared to STD-CPR (RR [Risk Ratio] = 1.21[1.01-1.46], 95% CI, p = 0.68, I² = 0). However, current meta-analyses with 3031 patients appeared to be inconclusive. There is a significant risk of type 1 error and therefore, results are potentially false positive. It is estimated that a minimal of 4331 patients needed to deem a conclusive result and a total of 5894 patients with similar risk profile required to stabilize statistic results in future trials. Quality of evidence is downgraded to moderate due to serious imprecision based on TSA.

CONCLUSION

Based on these analyses, evidence is inadequate to conclude the superiority of one CPR method over the other. Further trials with larger numbers of patients are needed to deem a conclusive and stable meta-analysis.

Frequency of Medical Reversal Among Published Randomized Controlled Trials Assessing Cardiopulmonary Resuscitation (CPR)

OBJECTIVE

To characterize what proportion of all randomized controlled trials (RCTs) among patients experiencing cardiac arrest find that an established practice is ineffective or harmful, that is, a medical reversal.

METHODS

We reviewed a database of all published RCTs of cardiac arrest patient populations between 1995 and 2014. Articles were classified on the basis of whether they tested a new or existing therapy and whether results were positive or negative. A reversal was defined as a negative RCT of an established practice. Further review and categorization were performed to confirm that reversals were supported by subsequent systematic review, as well as to identify the type of medical practice studied in each reversal. This study was conducted from October 2017 to June 17, 2019.

RESULTS

We reviewed 92 original articles, 76 of which could be conclusively categorized. Of these, 18 (24%) articles examined a new medical practice, whereas 58 (76%) tested an established practice. A total of 18 (24%) studies had positive findings, whereas 58 (76%) reached a negative conclusion. Of the 58 articles testing existing standard of care, 44 (76%) reversed that practice, whereas 14 (24%) reaffirmed it.

CONCLUSION

Reversal of cardiopulmonary resuscitation practices is widespread. This investigation sheds new light on low-value practices and patterns of medical research and suggests that novel resuscitation practices have low pretest probability and should be empirically tested with rigorous trials before implementation.

Hands-Only Cardiopulmonary Resuscitation Training in Schools: Impact of Legislation on the Future of School Nurses

BACKGROUND

Bystander cardiopulmonary resuscitation (CPR) initiated before medical help arrives saves lives. Hands-Only CPR keeps the blood flowing to the brain and other organs, increasing a person's chance of survival.

METHODS

A literature review identified Hands-Only CPR as the preferred method of CPR performed in the community setting. Many states have passed legislation making CPR education a high school graduation requirement.

RESULTS

School nurses can play a pivotal role as school districts address these new CPR requirements. The school nurse involvement in these newly mandated CPR training requirements can support student success and improve the health of communities.

CONCLUSIONS

School nurses need to use these newly mandated CPR training requirements as an opportunity to showcase the profession of nursing to ensure the school nurse remains present in our schools.

Measuring the effectiveness of a novel CPRcard™ feedback device during simulated chest compressions by non-healthcare workers

INTRODUCTION

There is a need for a simple-to-use and easy-to-carry CPR feedback device for laypersons. We aimed to determine if a novel CPRcard™ feedback device improved the quality of chest compressions.

METHODS

We compared participants' chest compression rate and depth with and without feedback. Compression data was captured through the CPRcard™ or Resusci Anne's SimPad® SkillReporter™. Compression quality was defined based on 2010 international guidelines for rate, depth and flow fraction.

RESULTS

Overall, the CPRcard group achieved a better median compression rate (CPRcard 117 vs. control 122, p = 0.001) and proportion of compressions within the adequate rate range (CPRcard 83% vs. control 47%, p < 0.001). Compared to the no-card and blinded-card groups, the CPRcard group had a higher proportion of adequate compression rate (CPRcard 88% vs. no-card 46.8%, p = 0.037; CPRcard 73% vs. blinded-card 43%, p = 0.003). Proportion of compressions with adequate depth was similar in all groups (CPRcard 52% vs. control 48%, p = 0.957). The CPRcard group more often met targets for compression rate of 100-120/min and depth of at least 5 cm (CPRcard 36% vs. control 4%, p = 0.022). Chest compression flow fraction rate was similar but not statistically significant in all groups (92%, p = 1.0). Respondents using the CPRcard expressed higher confidence (mean 2.7 ± 2.4; 1 = very confident, 10 = not confident).

CONCLUSION

Use of the CPRcard by non-healthcare workers in simulated resuscitation improved the quality of chest compressions, thus boosting user confidence in performing compressions.

Analyses of inter-rater reliability between professionals, medical students and trained school children as assessors of basic life support skills

BACKGROUND

Training of lay-rescuers is essential to improve survival-rates after cardiac arrest. Multiple campaigns emphasise the importance of basic life support (BLS) training for school children. Trainings require a valid assessment to give feedback to school children and to compare the outcomes of different training formats. Considering these requirements, we developed an assessment of BLS skills using MiniAnne and tested the inter-rater reliability between professionals, medical students and trained school children as assessors.

METHODS

Fifteen professional assessors, 10 medical students and 111-trained school children (peers) assessed 1087 school children at the end of a CPR-training event using the new assessment format. Analyses of inter-rater reliability (intraclass correlation coefficient; ICC) were performed.

RESULTS

Overall inter-rater reliability of the summative assessment was high (ICC = 0.84, 95 %-CI: 0.84 to 0.86, n = 889). The number of comparisons between peer-peer assessors (n = 303), peer-professional assessors (n = 339), and peer-student assessors (n = 191) was adequate to demonstrate high inter-rater reliability between peer- and professional-assessors (ICC: 0.76), peer- and student-assessors (ICC: 0.88) and peer- and other peer-assessors (ICC: 0.91). Systematic variation in rating of specific items was observed for three items between professional- and peer-assessors.

CONCLUSION

Using this assessment and integrating peers and medical students as assessors gives the opportunity to assess hands-on skills of school children with high reliability.

Cardiac Arrest Resuscitation

Cardiac arrest is a dynamic disease that tests the multitasking and leadership abilities of emergency physicians. Providers must simultaneously manage the logistics of resuscitation while searching for the cause of cardiac arrest. The astute clinician will also realize that he or she is orchestrating only one portion of a larger series of events, each of which directly affects patient outcomes. Resuscitation science is rapidly evolving, and emergency providers must be familiar with the latest evidence and controversies surrounding resuscitative techniques. This article reviews evidence, discusses controversies, and offers strategies to provide quality cardiac arrest resuscitation.