• Resuscitation · Dec 2015

    Review Meta Analysis

    When should chest compressions be paused to analyze the cardiac rhythm?: A systematic review and meta-analysis.

    • Joshua C Reynolds, Violetta Raffay, Eddy Lang, Peter T Morley, and Kevin Nation.
    • Department of Emergency Medicine, Michigan State University College of Human Medicine, 15 Michigan Street NE, Suite 420 Secchia Center, Grand Rapids, MI, 49503, United States. Electronic address: reyno406@msu.edu.
    • Resuscitation. 2015 Dec 1; 97: 38-47.

    ObjectivesMost guidelines recommend pausing chest compressions at 2 min intervals to analyze the cardiac rhythm. We conducted a systematic review and meta-analysis to define the optimal interval at which to pause chest compressions in adults for cardiac rhythm analysis in any setting.MethodsWe searched PubMed, Embase, and Cochrane databases through January 2, 2015, including human studies addressing any two different intervals of rhythm analysis. GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) methodology evaluated confidence in estimates of effect for evidence pertaining to functional outcome, survival, and return of spontaneous circulation.ResultsOf 1,136 identified papers, nine were included (three RCTs and six observational studies). Quality of evidence for each outcome was very low or low (usually downgraded risk of bias and indirectness). RCTs comparing specific intervals (3 min vs. immediate rhythm analysis; 1 vs. 2 min; 3 vs. 1 min) demonstrated no difference between either arm. Meta-analyses of observational studies demonstrated benefit for a bundled 'minimally interrupted chest compression' protocol dictating 200-compression intervals compared with historical controls treated with 1- or 3 min intervals per the 2000 guidelines (OR 1.85, 95% CI 1.27,2.68 for ROSC; OR 2.84, 95% CI 2.12,3.79 for survival to discharge; OR 2.94, 95% CI 1.60, 5.37 for good functional outcome).ConclusionThere is a paucity of quality evidence to support pausing chest compressions at any singular interval to assess the cardiac rhythm in adults in cardiac arrest in any setting. Very low-quality evidence suggests improved clinical outcomes in patients receiving 200-compression intervals compared with 1- or 3 min intervals.Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…