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Review Meta Analysis
The optimal surface for delivery of CPR: a systematic review and meta-analysis.
Interventions to stiffen the surface during CPR delivery have limited effect on chest compressions in manikin trials.
pearl- Josephine Holt, Abigail Ward, Tay-Yibah Mohamed, Priya Chukowry, Natalia Grolmusova, Keith Couper, Peter Morley, and Gavin D Perkins.
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- Resuscitation. 2020 Oct 1; 155: 159-164.
AimTo determine the effect of CPR delivery surface (e.g. firm mattress, floor, backboard) on patient outcomes and CPR delivery.MethodsWe searched Medline, Cochrane Library and Web of Science for studies published since 2009 that evaluated the effect of CPR delivery surface in adults and children on patient outcomes and quality of CPR. We included randomised controlled trials only. We identified pre-2010 studies from the 2010 ILCOR evaluation of this topic. Two reviewers independently screened titles/ abstracts and full-text papers, extracted data and assessed risk of bias. Evidence certainty for each outcome was evaluated using GRADE methodology. Where appropriate, we pooled data in a meta-analysis, using a random-effects model.ResultsDatabase searches identified 2701 citations. We included seven studies published since 2009. We analysed these studies together with the four studies included in the previous ILCOR review. All included studies were randomised controlled trials in manikins. Certainty of evidence was very low. Increasing mattress stiffness or moving the manikin from the bed to the floor did not improve compression depth. Use of a backboard marginally improved compression depth (mean difference 3 mm (95% CI 1-4).ConclusionThe use of a backboard led to a small increase in chest compression depth in manikin trials. Different mattress types or delivery of CPR on the floor did not affect chest compression depth. PROSPERO CRD42019154791.Copyright © 2020. Published by Elsevier B.V.
Notes
The most relevant takeaway from this meta-analysis is really just how poor a lot of the evidence around resuscitation and CPR is (not for lack of effort, but because of the obvious limitations of research around critical-event and end-of-life medicine). Not only was the analysed evidence of low certainty but notably all seven RCTs were manikin studies.
Manikins are designed for resuscitation education and training, not for physiological fidelity. Even if this study had shown an improvement in compression depth for different surfaces, it's relevance to CPR in flesh-and-blood humans would be no less questionable.
Daniel Jolley
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