Author(s): Gabrielle Nuthall and Fernanda Sa
Date: 17th December 2014
Question: Any specific chest compression depth compared to the depth specified in the current treatment algorithm for children and infants receiving chest compressions (in- or out-of hospital setting) change survival to 180 days with good neurological outcome, survival to
hospital discharge, complication rate or intermediate physiologic endpoints
Settings:
Bibliography (systematic reviews): 1) Resuscitation Jun 2009; 80 (6): 662-4 Depth of sternal compression and intra-arterial blood pressure during CPR in infants following cardiac surgery. Maher et al
Quality assessment
№ of
studies
Study design
Risk of
bias
Inconsistency
Indirectness
№ of patients
Imprecision
Other
considerations
any specific chest
compression depth
Effect
the depth specified in the current
treatment algorithm
Relative
(95% CI)
Quality
Importance
⨁◯
◯◯
IMPORTANT
Absolute
(95% CI)
Physiological end point study comparing BP at attempting chest compressions at 1/3 vs 1/2 AP diameter of chest. Aimed to achieve a mean systolic BP of 60-90 mmHg (assessed with: BP with arterial line 1/3 and 1/2 AP diameter by estimation) 3
1
observational
studies
serious
not serious
1
not serious
very
serious
none
6/6 (100.0%)
3
1/6 (16.7%)
2
not
estimable
not estimable
VERY LOW
Physiological endpoint study comparing BP in cardiac arrests that did, and did not achieved AHA recommended rate and depth (corrected depth > 38 mm). Hypothesis that those that achieved recommendations would achieve a systolic BP > 80 mmHg and a diastolic > 30 mmHg (assessed with:
Arterial BP) 6
1
observational
studies
not
serious
not serious
4
not serious
serious
5
none
6
7
OR 1.04
(0.63 to
1.71)
1 fewer per 1000 (from 0 fewer to 0
fewer)
⨁◯
◯◯
IMPORTANT
VERY LOW
MD – mean difference, RR – relative risk
1.
2.
3.
4.
5.
6.
7.
Maher: for these 6 patients there were no reasons to suspect heterogeneity and they all acted as their own controls.
Maher: very small sample size - only six patients
Maher K et al. Depth of sternal compression and intra-arterial blood pressure during CPR in infants following Cardiac Surgery. Resuscitation 80 (2009) 662-664
Sutton 2013: prospective observational study, patients < 18 years of age, small study, 9 patients, median age 14 yrs, range 1.75 yrs - 17 yrs, only 2 patients under 13 yrs. Study done at time of 2005 guidelines, and chest compression depths corrected for
mattress deflections. Feedback from QCPR device provided to those > 8 yrs old, but not less than 8 yrs old. takes 1-2 minutes post arrest to apply QCPR device and then the first 1000 delivered compressions were included in the analysis. ROSC was obtained
in 2 (22%).Hypothesis was that AHA compliant events would be associated with a systolic BP > 80 and a diastolic BP > 30, they had excellent reasons (as detailed in paper) for choosing these cutoffs. Automated feedback was supplied to those over 8 yrs of
age, feedback switched off for those under 8 yrs of age.
Sutton 2013; small sample size of only 9 patients.
Sutton R et al. American Heart Association cardiopulmonary resuscitation quality targets are associated with improved arterial blood pressure during pediatric cardiac arrest. Resuscitation 84 (2013) 168-172
The OR given in the next box is for a systolic BP > 80, for a diastolic BP > 30 the OR is 0.97 with CI's 0.52-1.79