Author(s): Gabrielle Nuthall and Fernanda Sa
Date: 17th December 2014
Question: AHA compliant chest compression depths > 51mm compared to chest compression depth < 50mm for children > 1 year who receive cardiac compressions
Settings:
Bibliography (systematic reviews):
Quality assessment
№ of
studies
Study design
Risk of
bias
Inconsistency
№ of patients
Indirectness
Imprecision
Other
considerations
AHA compliant chest compression
depths > 51mm
Effect
chest compression depth <
50mm
Relative
(95% CI)
Absolute
(95% CI)
3/64 (4.7%)
not
estimable
not estimable
Quality
Importance
⨁◯
◯◯
CRITICAL
Survival with good neurological outcome (assessed with: PCPC 1-2 at discharge or no change from baseline)
1
observational
studies 1
serious
2
not serious
serious
3
very
serious
none
4/23 (17.4%)
5
4
VERY LOW
Survival to discharge
1
observational
studies
serious
2
not serious
serious
3
very
serious
none
5/23 (21.7%)
4/64 (6.3%)
4
not
estimable
not estimable
⨁◯
◯◯
CRITICAL
VERY LOW
24 hour survival
1
observational
studies
serious
2
not serious
serious
3
serious
6
none
16/23 (69.6%)
10/64 (15.6%)
OR 10.3
(2.75 to
38.8)
500 more per 1000 (from 181 more
to 722 more)
⨁◯
◯◯
IMPORTANT
7
VERY LOW
Return of spontaneous circulation
1
observational
studies
serious
2
not serious
serious
3
serious
4
none
17/23 (73.9%)
20/64 (31.3%)
OR 4.21
(1.34 to
13.2)
344 more per 1000 (from 66 more to
545 more)
⨁◯
◯◯
VERY LOW
MD – mean difference, RR – relative risk
IMPORTANT
8
1.
2.
3.
4.
5.
6.
7.
8.
Sutton 2014 2010 AHA recommended compression depths during pediatric in-hospital resuscitations are associated with survival. A prospective observational study of 89 children > 1 yr of age who received cardiac compressions in an intensive care unit or
emergency departments of a tertiary children's hospital.
Study included only children > 1 year and out of 78 patients only 8 were < 8 yrs old. All were in- hospital and received continuous chest compressions as intubated and ventilated. PICO question states infants and children in and out of hospital, so paper only
covers a narrow part of this total population.Study done in a centre with a record of excellent CPR education. Quality of CPR/depth of chest compressions measured with QCPR - transferable to instructions to compress chest > 50 mm.
Downgrade to serious not very serious if analyse all as in-hospital as there is no out of hospital data for this group. Still have to downgrade as no infants under 1 yr of age and only 8/87 < 8 yrs of age. Single centre, in house attending, all intubated with
continuous chest compressions, all had QCPR, which all affect if the result is generalizable and applicable to the wider population. However no difference in baseline risk for in hospital population in similar setting and no physiological reason why there would be
a difference in other populations.
sample size ralated
Control group put as those achieving > 51vmm as this is current guideline and intervention put as group achieving < 51 mm even though this is not desirable.
No explanation was provided
This was not an original outcome as decided upon by the task force, so I have graded it's outcome as 5
This was not an original outcome as decided upon by the task force so I have graded its importance as 5