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Evidence summaries

Continuous Versus Interrupted Chestcompression for Cardiopulmonary Resuscitation of Nonasphyxialout-of-Hospital Cardiac Arrest

Continuous chest compression performed by untrained bystanders appears to improve survival compared to interrupted chest compression for cardiopulmonary resuscitation of nonasphyxial out-of-hospital cardiac arrest (OHCA). On the other hand, when administered by EMS professionals, continuous chest compression with asynchronous rescue breathing appears not to improve survival compared to interrupted chest compression with rescue breathing. Level of evidence: "B"

Summary

A Cochrane review [Abstract] 1 included 4 studies with a total of 26742 subjects. Three studies assessed CPR provided by untrained bystanders (3737 participants) who administered CPR under telephone instruction from emergency services. One of these included out-of-hospital cardiac arrest (OHCA) patients who were equal to, or older than eight years of age, and the other two trials provided no information regarding the age of the participants. The fourth study compared approaches given by EMS professionals (23,711 participants); it included only adult OHCA. All studies were undertaken in rural areas.

When CPR was performed by bystanders T1, more people survived until discharge from hospital after chest compression alone than they did following interrupted chest compression with pauses at a fixed ratio for rescue breathing (15 compressions to 2 breaths). For this outcome the quality of the evidence was high. For survival to hospital admission and neurological outcomes at hospital discharge the evidence was moderate.

When CPR was performed by EMS professionals T2, survival to hospital discharge was slightly lower with continuous chest compressions (100/minute) plus asynchronous rescue breathing (10/minutes) CPR compared with interrupted chest compression plus rescue breathing. The quality of the evidence was moderate for the outcome of survival to hospital discharge. For survival to hospital admission and neurological outcomes at hospital discharge there was high-quality evidence.

Continuous chest compression alone compared to interrupted chest compression plus artificial ventilation for non asphyxial out-of-hospital cardiac arrest performed by untrained bystanders.

OutcomeParticipants(studies)Relative effect(95% CI)Assumed risk - Interrupted chest compression plus ventilationCorresponding risk - Continuous chest compression alone
Survival to hospital discharge3031(3)RR 1.21 (1.01 to 1.46)116 per 1000141 per 1000 (117 to 170)
Survival to hospital admission520(1)RR 1.18(0.94 to 1.48)341 per 1000402 per 1000 (320 to 504)
Neurological outcomes at hospital discharge (Measured as 'good' or 'moderate' with Cerebral Performance Category classification)1286(1)RR 1.25(0.94 to 1.66)110 per 1000138 per 1000 (103 to 183)

Continuous chest compression plus ventilation compared to interrupted chest compression plus ventilation for patients with non asphyxial out-of-hospital cardiac arrest performed by emergency medical staff.

OutcomeParticipants(studies)Adjusted risk difference(95% CI)Assumed risk - interrupted chest compression plus ventilationCorresponding risk - Continuous chest compression with asynchronous rescue breathing
Survival to hospital discharge23,648(1)ARD -0.7%(-1.5% to 0.1%)97 per 100090 per 1000 (82 to 98)
Survival to hospital admission23,711(1)ARD -1.3%(-2.4% to -0.2%)259 per 1000246 per 1000 (235 to 257)
Neurological outcomes at hospital discharge (Rankin score HASH(0x2fd0288) 3)23,555(1)ARD -0.6%(-1.4% to 0.1%)77 per 100070 per 1000(56 to 78)

Clinical comments

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    References

    • Zhan L, Yang LJ, Huang Y et al. Continuous chest compression versus interrupted chest compression for cardiopulmonary resuscitation of non-asphyxial out-of-hospital cardiac arrest. Cochrane Database Syst Rev 2017;3:CD010134. [PubMed]

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