• Ryan Dee, Michael Smith, Kausala Rajendran, Gavin D Perkins, Christopher M Smith, Christian Vaillancourt, Suzanne Avis, Steven Brooks, Maaret Castren, Sung Phil Chung, Julie Considine, Raffo Escalante, Lim Swee Han, Tetsuo Hatanaka, Mary Fran Hazinski, Kevin Hung, Peter Kudenchuk, Peter Morley, Kee-Chong Ng, Chika Nishiyama, Federico Semeraro, Michael Smyth, and International Liaison Committee on Resuscitation Basic Life Support Task Force Collaborators.
• Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
• Resuscitation. 2021 May 1; 162: 738173-81.

BackgroundCardiopulmonary resuscitation (CPR) improves cardiac arrest survival. Cough CPR, percussion pacing and precordial thump have been reported as alternative CPR techniques. We aimed to summarise in a systematic review the effectiveness of these alternative CPR techniques.MethodsWe searched Ovid MEDLINE, EMBASE and the Cochrane Library on 24/08/2020. We included randomised controlled trials, observational studies and case series with five or more patients. Two reviewers independently reviewed title and abstracts to identify studies for full-text review, and reviewed bibliographies and 'related articles' (using PubMed) of full-texts for further eligible studies. We extracted data and performed risk-of-bias assessments on studies included in the systematic review. We summarised data in a narrative synthesis, and used GRADE to assess evidence certainty.ResultsWe included 23 studies (cough CPR n = 4, percussion pacing n = 4, precordial thump n = 16; one study studied two interventions). Only two (both precordial thump) had a comparator group ('standard' CPR). For all techniques evidence certainty was very low. Available evidence suggests that precordial thump does not improve survival to hospital discharge in out-of-hospital cardiac arrest. The review did not find evidence that cough CPR or percussion pacing improve clinical outcomes following cardiac arrest.ConclusionCough CPR, percussion pacing and precordial thump should not be routinely used in established cardiac arrest. In specific inpatient, monitored settings cough CPR (in conscious patients) or percussion pacing may be attempted at the onset of a potential lethal arrhythmia. These must not delay standard CPR efforts in those who lose cardiac output.Prospero Registration NumberCRD42019152925.Copyright © 2021 Elsevier B.V. All rights reserved.

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