Elsevier

Resuscitation

Volume 146, 1 January 2020, Pages 188-202
Resuscitation

Review
Chest compression components (rate, depth, chest wall recoil and leaning): A scoping review

https://doi.org/10.1016/j.resuscitation.2019.08.042Get rights and content

Abstract

Aim

To understand whether the science to date has focused on single or multiple chest compression components and identify the evidence related to chest compression components to determine the need for a full systematic review.

Methods

This review was undertaken by members of the International Liaison Committee on Resuscitation and guided by a specific methodological framework and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Studies were eligible for inclusion if they were peer-reviewed human studies that examined the effect of different chest compression depths or rates, or chest wall or leaning, on physiological or clinical outcomes. The databases searched were MEDLINE complete, Embase, and Cochrane.

Results

Twenty-two clinical studies were included in this review: five observational studies involving 879 patients examined both chest compression rate and depth; eight studies involving 14,285 patients examined chest compression rate only; seven studies involving 12001 patients examined chest compression depth only, and two studies involving 1848 patients examined chest wall recoil. No studies were identified that examined chest wall leaning. Three studies reported an inverse relationship between chest compression rate and depth.

Conclusion

This scoping review did not identify sufficient new evidence that would justify conducting new systematic reviews or reconsideration of current resuscitation guidelines. This scoping review does highlight significant gaps in the research evidence related to chest compression components, namely a lack of high-level evidence, paucity of studies of in-hospital cardiac arrest, and failure to account for the possibility of interactions between chest compression components.

Introduction

In 2015, the International Liaison Committee on Resuscitation (ILCOR) published the International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) Science with Treatment Recommendations (CoSTR) on Adult Basic Life Support (BLS) and Automated External Defibrillation.1, 2 This CoSTR was underpinned by systematic reviews of 23 PICO questions (Population, Intervention, Comparator, Outcome) and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodological approach.3 There were three systematic reviews related to three main components of chest compression (CC); namely, CC rate, CC depth, and chest wall recoil.1, 2 However, these systematic reviews were performed specifically for each component and did not take into account their potential interactions. In addition, chest wall leaning was not evaluated as a parameter independent of chest wall recoil.

Traditionally ILCOR has published BLS CoSTRs in 5-year cycles (2005,4, 5 2010,6, 7 20151, 2). However, ILCOR has now moved to a continuous evidence evaluation process.8 Part of this new approach requires the ILCOR Task Forces to determine whether a sufficient body of evidence has emerged to justify re-visiting a previous CoSTR or whether the previous recommendations may still be considered valid. In November 2018, at the ILCOR meeting in Chicago, the BLS Task Force decided to reactivate the PICOs related to CC rate, CC depth, and chest wall recoil, acknowledging that further work was required to understand whether there was new science published to date that provided more information on these CC components as discrete entities or whether studies have reported interactions between these CC components. Therefore, a scoping review was undertaken with the following aims: i) to understand whether the science to date has focused on single CC components or interactions between CC components and ii) to identify the evidence related to the CC components to determine whether the body of evidence published since the 2015 BLS CoSTR1, 2 indicates the need for a full systematic review of the evidence related to CC components.

The purpose of scoping reviews is to identify the available evidence related to a specific topic.9 The major difference between scoping reviews and systematic reviews is that scoping reviews have a broader inclusion criteria whereas traditional systematic reviews address a narrow, clearly defined question.9 In addition, the primary outcome of a scoping review is the volume of literature, types of studies conducted, and the outcomes examined, to date rather than pre-defined clinical outcomes that are typically examined in a systematic review. In this scoping review, we present the types of studies of CC components conducted and the outcomes examined understand to address the first aim, and data related to clinical outcomes are presented to address the second aim.

Section snippets

Methods

This scoping review was guided by the methodological framework developed by Arksey and O’Malley,10 which comprises the following elements: identify the research question; search for relevant studies; select studies; chart the data; collate, summarise, and report the results according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR).11 In scoping reviews, formal quality assessment is not usually performed and study findings are

Results

After removal of duplicates, our search returned 2830 publications. Two 2015 ILCOR BLS CoSTR1, 2 studies were excluded during title and abstract screening because they were animal studies. In total, 53 full text publications were screened for eligibility: 35 studies from the 2019 search and 18 studies from the 2015 ILCOR BLS CoSTR.1, 2 Following screening of the 53 full-text publications, 31 were excluded because they were abstract only publications (n = 15), did not meet the inclusion criteria

Discussion

This scoping review identified 22 studies related to various CC components, eighteen of which were observational studies.21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 34, 35, 36, 37, 38, 39, 41, 42 There was variation in the outcomes examined and overall the most frequently reported outcomes were ROSC (n = 13),22, 25, 26, 27, 28, 29, 30, 33, 34, 35, 38, 39, 41 survival to hospital discharge (n = 12),22, 26, 27, 28, 29, 33, 34, 35, 36, 38, 41, 42 and survival to hospital discharge with good

Conclusions

This scoping review demonstrated that the majority of studies focused on a single CC component, whereas a number of studies suggest the presence of confounding interactions that prompt caution when evaluating any CC component in isolation. Although this scoping review has not identified sufficient new evidence to prompt new systematic reviews or reconsideration of current resuscitation guidelines, it highlights significant gaps in the research evidence related to CC components, namely a lack of

Conflicts of interest

Julie Considine: None.

Raúl J. Gazmuri: None.

Gavin D. Perkins: Co-chair ILCOR, Board member European Resuscitation Council, Executive member Resuscitation Council (UK), Editor Resuscitation.

Peter J. Kudenchuk: National Institutes of Health (NIH) grant support as principal investigator of the SIREN Network at the University of Washington; (unpaid) volunteer American Heart Association Guidelines Update Writing Group.

Theresa M. Olasveengen: None.

Christian Vaillancourt: None.

Chika Nishiyama: None.

Acknowledgements

The authors wish to acknowledge the contribution of members of the International Liaison Committee on Resuscitation Basic Life Support Task Force to this scoping review.

References (48)

  • R.M. Sutton et al.

    Chest compression rates and pediatric in-hospital cardiac arrest survival outcomes

    Resuscitation

    (2018)
  • J.H. Kilgannon et al.

    Association between chest compression rates and clinical outcomes following in-hospital cardiac arrest at an academic tertiary hospital

    Resuscitation

    (2017)
  • R.M. Sutton et al.

    2010 American Heart Association recommended compression depths during pediatric in-hospital resuscitations are associated with survival

    Resuscitation

    (2014)
  • T. Vadeboncoeur et al.

    Chest compression depth and survival in out-of-hospital cardiac arrest

    Resuscitation

    (2014)
  • H. Hellevuo et al.

    Deeper chest compression – more complications for cardiac arrest patients?

    Resuscitation

    (2013)
  • C.F. Babbs et al.

    A new paradigm for human resuscitation research using intelligent devices

    Resuscitation

    (2008)
  • A. Bohn et al.

    The addition of voice prompts to audiovisual feedback and debriefing does not modify CPR quality or outcomes in out of hospital cardiac arrest – a prospective, randomized trial

    Resuscitation

    (2011)
  • S. Cheskes et al.

    The association between chest compression release velocity and outcomes from out-of-hospital cardiac arrest

    Resuscitation

    (2015)
  • A. Kovacs et al.

    Chest compression release velocity: association with survival and favorable neurologic outcome after out-of-hospital cardiac arrest

    Resuscitation

    (2015)
  • R.M. Sutton et al.

    First quantitative analysis of cardiopulmonary resuscitation quality during in-hospital cardiac arrests of young children

    Resuscitation

    (2014)
  • A.H. Travers et al.

    Part 3: adult basic life support and automated external defibrillation 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations

    Circulation

    (2015)
  • Schünemann H, Brożek J, Guyatt G, Oxman A, editors. Handbook for grading the quality of evidence and the strength of...
  • International Liaison Committee on Resuscitation

    Part 2. Adult basic life support. 2005 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations

    Resuscitation

    (2005)
  • International Liaison Committee on Resuscitation et al.

    Part 2: adult basic life support

    Circulation

    (2005)
  • Cited by (42)

    • Cardiovascular Pharmacology

      2022, Emergency Medicine Clinics of North America
    View all citing articles on Scopus
    View full text