Hemodynamic Effect of External Chest Compressions at the Lower End of the Sternum in Cardiac Arrest Patients

Cha, Kyoung‐Chul; Kim, Ho Jung; Shin, Hyung Jin; Kim, Hyun; Lee, Kang Hyun; Hwang, Sung Oh

doi:10.1016/j.jemermed.2012.09.026

Cited by 51 publications

(26 citation statements)

References 27 publications

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“…66,80,[95][96][97][98][99][100][101][102][103][104][105] Differences were detected between different CPR techniques, although this was not consistent across different modalities. Given the heterogeneity of CPR techniques used across studies, data could not be pooled.…”

Section: Consensus On Sciencementioning

confidence: 91%

Part 4: Advanced Life Support

Nolan¹,

Hazinski²,

Aickin³

et al. 2015

Circulation

554

125

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Questions to be addressed (using the PICO [population, intervention, comparator, outcome] format) 3 were prioritized by ALS Task Force members (by voting). Prioritization criteria included awareness of significant new data and new controversies or questions about practice. Questions about topics no longer relevant to contemporary practice or where little new research has occurred were given lower priority. The ALS Task Force prioritized 42 PICO questions for review. With the assistance of information specialists, a detailed search for relevant articles was performed in each of 3 online databases (PubMed, Embase, and the Cochrane Library).By using detailed inclusion and exclusion criteria, articles were screened for further evaluation. The reviewers for each question created a reconciled risk of bias assessment for each of the included studies, using state-of-the-art tools: Cochrane for randomized controlled trials (RCTs), 4 Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 for studies of diagnostic accuracy, 5 and GRADE for observational studies that inform both therapy and prognosis questions. 6 GRADE evidence profile tables 7 were then created to facilitate an evaluation of the evidence in support of each of the critical and important outcomes. The quality of the evidence (or confidence in the estimate of the effect) was categorized as high, moderate, low, or very low, 8 based on the study methodologies and the 5 core GRADE domains of risk of bias, inconsistency, indirectness, imprecision, and other considerations (including publication bias). 9 These evidence profile tables were then used to create a written summary of evidence for each outcome (the consensus on science statements). Whenever possible, consensus-based treatment recommendations were then created. These recommendations (designated as strong or weak) were accompanied by an overall assessment of the evidence and a statement from the task force about the values, preferences, and task force insights that underlie the recommendations. Further details of the methodology that underpinned the evidence evaluation process are found in "Part 2: Evidence Evaluation and Management of Conflicts of Interest."The task force preselected and ranked outcome measures that were used as consistently as possible for all PICO questions. Longer-term, patient-centered outcomes were considered more important than process variables and shorter-term outcomes. For most questions, we used the following hierarchy starting with the most important: long-term survival with neurologically favorable survival, long-term survival, short-term survival, and process variable. In general, longterm was defined as from hospital discharge to 180 days or longer, and short-term was defined as shorter than to hospital discharge. For certain questions (eg, related to defibrillation or confirmation of tracheal tube position), process variables such as termination of fibrillation and correct tube placement were important. A few questions (eg, organ donation) required unique outcomes....

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Section: Consensus On Sciencementioning

confidence: 91%

Part 4: Advanced Life Support

Nolan¹,

Hazinski²,

Aickin³

et al. 2015

Circulation

554

125

View full text Add to dashboard Cite

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“…[52][53][54] These investigations assessed hand placement on the lower third of the sternum compared with the center of the chest in a crossover design, and they measured physiologic endpoints, such as blood pressure and end-tidal carbon dioxide (ETCO 2 ). The studies have not provided conclusive or consistent results about the effects of hand placement on resuscitation outcomes.…”

Section: Summary Of Evidencementioning

confidence: 99%

Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality

Kleinman¹,

Brennan²,

Goldberger³

et al. 2015

Circulation

777

311

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“…[124][125][126] One crossover study in 17 adults with prolonged resuscitation from nontraumatic cardiac arrest observed improved peak arterial pressure during compression systole (114 ± 51 mm Hg versus 95 ± 42 mm Hg) and end-tidal carbon dioxide (ETCO 2 ; 11.0 ± 6.7 mm Hg versus 9.6 ± 6.9 mm Hg) when compressions were performed in the lower third of the sternum compared with the center of the chest, whereas arterial pressure during compression recoil, peak right atrial pressure and coronary perfusion pressure did not differ. 124 A second crossover study in 30 adults observed no difference between ETCO 2 values and hand placement. 125 A further crossover study in 10 children observed higher peak systolic pressure and higher mean arterial blood pressure when compressions were performed on the lower third of the sternum compared with the middle of the sternum.…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 3: Adult Basic Life Support and Automated External Defibrillation

Travers¹,

Perkins²,

Berg³

et al. 2015

Circulation

234

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Introduction This Part of the 2015 International Consensus on Cardiopul monary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) Science With Treatment Recommendations (CoSTR) presents the consensus on science and treatment recommendations for adult basic life support (BLS) and automated external defibrillation (AED). After the publication of the 2010 CoSTR, the Adult BLS Task Force developed review questions in PICO (population, intervention, comparator, outcome) format.1 This resulted in the generation of 36 PICO questions for systematic reviews. The task force discussed the topics and then voted to prioritize the most important questions to be tackled in 2015. From the pool of 36 questions, 14 were rated low priority and were deferred from this round of evidence evaluation. Two new questions were submitted by task force members, and 1 was submitted via the public portal. Two of these (BLS 856 and BLS 891) were taken forward for evidence review. The third question (368: ForeignBody Airway Obstruction) was deferred after a preliminary review of the evidence failed to identify compelling evidence that would alter the treatment recommendations made when the topic was last reviewed in 2005. 2 Each task force performed a systematic review using detailed inclusion and exclusion criteria, based on the recommendations of the Institute of Medicine of the National Academies.3 With the assistance of information specialists, a detailed search for relevant articles was performed in each of 3 online databases (PubMed, Embase, and the Cochrane Library).Reviewers were unable to identify any relevant evidence for 3 questions (BLS 811, BLS 373, and BLS 348), and the evidence review was not completed in time for a further question (BLS 370). A revised PICO question was developed for the opioid question (BLS 891). The task force reviewed 23 PICO questions for the 2015 consensus on science and treatment recommendations, including BLS 811, BLS 373, and BLS 348. The PICO flow is summarized in Figure 1.Using the methodological approach proposed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group, 4 the reviewers for each question created a reconciled risk-of-bias assessment for each of the included studies, using state-of-the-art tools: Cochrane for randomized controlled trials (RCTs), 5 Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 for studies of diagnostic accuracy, 6 and GRADE for observational studies that inform both therapy and prognosis questions.7 GRADE evidence profile tables 8 were then created to facilitate an evaluation of the evidence in support of each of the critical and important outcomes. Critical outcomes were defined as neurologically favorable outcome (level 9), survival (level 8), and return of spontaneous circulation (ROSC; level 7). Given the heterogeneity of time points evaluated in the studies related to BLS/AED, time intervals were pooled across outcomes. For neurologic outcome and survival, we considered the outcomes at discharge,...

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Hemodynamic Effect of External Chest Compressions at the Lower End of the Sternum in Cardiac Arrest Patients

Cited by 51 publications

References 27 publications

Part 4: Advanced Life Support

Part 4: Advanced Life Support

Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality

Part 3: Adult Basic Life Support and Automated External Defibrillation

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