Quantifying the Effect of Cardiopulmonary Resuscitation Quality on Cardiac Arrest Outcome

Abstract

Background-Evidence has accrued that cardiopulmonary resuscitation quality affects cardiac arrest outcome. However, the relative contributions of chest compression components (such as rate and depth) to successful resuscitation remain unclear.Methods and Results-We sought to measure the effect of cardiopulmonary resuscitation quality on cardiac arrest outcome through systematic review and meta-analysis. We searched for any clinical study assessing cardiopulmonary resuscitation performance on adult cardiac arrest patients in which survival was a reported outcome, either return of spontaneous circulation or survival to admission or discharge. Of 603 identified abstracts, 10 studies met inclusion criteria. Effect sizes were reported as mean differences. Missing data were resolved by author contact. Estimates were segregated by cardiopulmonary resuscitation metric (chest compression rate, depth, no-flow fraction, and ventilation rate), and a random-effects model was applied to estimate an overall pooled effect. Arrest survivors were significantly more likely to have received deeper chest compressions than nonsurvivors (mean difference, 2.44 mm; 95% confidence interval, 1.19-3.69 [P<0.001]; n=6 studies; I 2 =0.0%; P for heterogeneity=0.9). Likewise, survivors were significantly more likely to have received chest compression rates closer to 85 to 100 compressions per minute (cpm) than nonsurvivors (absolute mean difference from 85 cpm, −4.81 cpm; 95% confidence interval, −8.19 to −1.43 [P=0.005]; from 100 cpm, −5.04 cpm; 95% confidence interval, −8.44 to −1.65 [P=0.004]; n=6 studies; I 2 <49%; P for heterogeneity >0.2). No significant difference in no-flow fraction (n=7 studies) or ventilation rate (n=4 studies) was detected between survivors and nonsurvivors. Conclusions-Deeper

Factors influencing high-quality chest compressions during cardiopulmonary resuscitation scenario, according to 2015 American Heart Association Guidelines

“…Chest compression depth is an important component of CPR and should be measured routinely [19,20], the most effective depth is currently unknown. In our study, we obtained mean CC depth on 49.7 ± 8.4 mm.…”

“…In case of the CC rate recommended in ERC guidelines, ROSC was observed in 29%. Moreover, Wallace et al [20] presented a meta-analysis which stressed that CC rates closer to 85-100 cpm are significantly associated with improved survival from cardiac arrest. In our study the participants performed CCs according to international resuscitation guidelines (113.7 ± 14.2/min).…”

Part 1: Executive Summary

“…For healthcare professionals, the quality of CPR delivered is critical because poor compliance with recommended guidelines has been associated with lower survival. 116,117 Suboptimal CPR harms patients 118 and is preventable. 119 Quality improvement processes are needed to try to minimize its occurrence.…”

The impact of prehospital resuscitation research on in-hospital care

“…[10][11][12][13][14] A metaanalysis by Wallace et al found that survival was improved with chest compression depths of at least 51 mm and compression rates between 85 and 100 compressions per minute. 14 Vadeboncoeur et al conducted an observational study examining the influence of an educational intervention on high quality CPR and its impact on neurologically intact survival from OHCA and found that chest compressions with a depth of at least 51 mm were independently associated with survival from cardiac arrest with a favourable neurologic outcome. 13 …”