Continuous chest compression versus interrupted chest compression for cardiopulmonary resuscitation… of nonasphyxial out-of-hospital cardiac arrest Dr Daniel MEYRAN, for the PEC Cochrane Cochrane Data Base of Systematic, Revue 2017, issue 3. art. N°: CD010134

Objectifs Population : AC extrahospitaliers d’origine cardiaque chez l’adulte et l’enfant. Intervention : RCP compressions thoraciques continues avec VA (secouristes) ou sans VA (premiers témoins guidés par téléphone, sauveteurs) Comparison : RCP compressions thoraciques discontinues avec VA (15:2, 30:2) Outcomes : Survie à la sortie de l’hôpital, arrivée vivant à l’hôpital, état neurologique à la sortie de l’hôpital Etudes : ECR, non-ECR, cluster ECR The first review on continuous chest compression-only CPR was published in the Lancet (Hüpfl 2010). The Cochrane consider that a review is necessary to compared the effects of the two treatments when they were given by bystanders at the scene of a non-asphyxial OHCA and by ambulance crews who arrive later. (A non-asphyxial arrest does not result from drowning or choking.) The review question is addressed by two separate comparisons. Bystander-administered continuous chest compression CPR only versus interrupted chest compression plus artificial ventilation for an out-of-hospital cardiac arrest. Emergency service personnel-administered continuous chest compression with asynchronous ventilation versus interrupted chest compression plus artificial ventilation following dispatch to an out-of-hospital cardiac arrest. Types of outcome measures Primary outcomes 1. Survival to hospital discharge. 2. Survival to hospital admission. Secondary outcomes Survival at one year, 2. Neurological outcomes at hospital discharge and at one year, 3. Return of spontaneous circulation (ROSC), 4. Quality of life, 5. Any adverse effects. 3 études randomizées et controlées, 1 cluster

RCP CT discontinue avec VA RCP CT continues / RCP CT discontinues : témoins non formés guidés par téléphone Survie à la sortie de l’hôpital RCP CT discontinue avec VA RCP CT seules Résults 3 trials (Hallstrom 2000; Rea 2010; Svensson 2010). In all 3trials (Hallstrom 2000; Rea 2010; Svensson 2010) the dispatcher gave the bystanders instructions via the telephone on either continuous chest compression-only CPR or conventional (interrupted chest compression with pauses at a fixed rate for rescue breathing) CPR. In the intervention group, continuous chest compressions were performed without rescue breathing. In the control group, interrupted chest compressions plus rescue breathing were performed in a ratio of 2 to 15. In all 3 trials, CPR was performed by bystanders who had not been trained. All 3 trials reported survival to hospital discharge. Rea 2010 reported a favourable neurologic status at the time of hospital discharge, defined as a CPC of 1 or 2, but one study in this study site was unable to assess it (selective reporting). Hallstrom 2000 reported admission to hospital. They also reported the neurological status in the survivors, however, they did not describe whether or not the neurologic status was measured by the CPC. Effects Survival to hospital discharge All three trials in the bystander-provided CPR comparison reported survival to hospital discharge (Hallstrom 2000; Rea 2010; Svensson 2010). There were 1500 participants recruited in the intervention group, and 1531 in the control group. There were no significant differences between the two groups in the trials. The pooled result showed better survival for the continuous chest compression alone group, high-quality evidence. Survival to hospital admission Only one trial reported this outcome (Hallstrom 2000). The result showed no significant difference between the two groups. We judged the evidence to be of moderate-quality for this outcome due to imprecision. Neurological outcomes at hospital discharge Only one trial reported neurological outcomes at hospital discharge (Rea 2010); the results showed no significant differences between the two groups in the number of patients with a CPC classification of 1 or 2; moderate-quality evidence due to imprecision. Niveau de preuve : élevée ⊕⊕⊕⊕ Grade:

Autres résultats  Témoins non formés guidés par téléphone Autres résultats  Témoins non formés guidés par téléphone Survie à l’arrivée à l’hôpital : RR 1.18 (0.94 to 1.48)* Etat neurologique à la sortie de l’hôpital : RR 1.25 (0.94 to 1.66)*  Professionnels du secours* Pas de différence significative entre les compressions thoraciques discontinues + VA et compressions thoracique continues + VA asynchrone (*) 1 étude Résults 3 trials (Hallstrom 2000; Rea 2010; Svensson 2010). In all 3trials (Hallstrom 2000; Rea 2010; Svensson 2010) the dispatcher gave the bystanders instructions via the telephone on either continuous chest compression-only CPR or conventional (interrupted chest compression with pauses at a fixed rate for rescue breathing) CPR. In the intervention group, continuous chest compressions were performed without rescue breathing. In the control group, interrupted chest compressions plus rescue breathing were performed in a ratio of 2 to 15. In all 3 trials, CPR was performed by bystanders who had not been trained. All 3 trials reported survival to hospital discharge. Rea 2010 reported a favourable neurologic status at the time of hospital discharge, defined as a CPC of 1 or 2, but one study in this study site was unable to assess it (selective reporting). Hallstrom 2000 reported admission to hospital. They also reported the neurological status in the survivors, however, they did not describe whether or not the neurologic status was measured by the CPC. Effects Survival to hospital discharge All three trials in the bystander-provided CPR comparison reported survival to hospital discharge (Hallstrom 2000; Rea 2010; Svensson 2010). There were 1500 participants recruited in the intervention group, and 1531 in the control group. There were no significant differences between the two groups in the trials. The pooled result showed better survival for the continuous chest compression alone group, high-quality evidence. Survival to hospital admission Only one trial reported this outcome (Hallstrom 2000). The result showed no significant difference between the two groups. We judged the evidence to be of moderate-quality for this outcome due to imprecision. Neurological outcomes at hospital discharge Only one trial reported neurological outcomes at hospital discharge (Rea 2010); the results showed no significant differences between the two groups in the number of patients with a CPC classification of 1 or 2; moderate-quality evidence due to imprecision.

Take Home Message La RCP d’un ACEH d’origine cardiaque doit être réalisée de préférence avec : des compressions thoraciques continues si elle est faite par un témoin non formé, guidé par téléphone. des compressions thoraciques (plutôt discontinues) associées à une ventilation artificielle si elle est faite par des professionnels du secours. Conclusion According to our pooled results, when CPR was performed by untrained bystanders who were assisted by receiving telephone instruction Instruction from emergency services, continuous chest compression only CPR led to more people surviving to hospital discharge compared with interrupted chest compression plus artificial ventilation CPR for non asphyxial OHCA. The difference in survival to hospital discharge is about 25 more people per 1000 following bystander administered continuous chest compression. When CPR was performed by professional providers, continuous chest compressions with asynchronous rescue breathing did not result in higher rates of survival compared with interrupted chest compressions plus rescue breathing CPR for non asphyxial OHCA. The results indicate slightly lower rates of survival to admission or discharge, favourable neurological outcome and return of spontaneous circulation observed following continuous chest compression. Adverse effects were slightly lower with continuous chest compression.

Recherches futures Analyser les effets adverses, les effets neurologiques à long terme et la qualité de vie. les effets de la RCP CTS associée à l’usage du DAE. La RCP CTS est-elle appropriée chez l’enfant ? Conclusion According to our pooled results, when CPR was performed by untrained bystanders who were assisted by receiving telephone instruction Instruction from emergency services, continuous chest compression only CPR led to more people surviving to hospital discharge compared with interrupted chest compression plus artificial ventilation CPR for non asphyxial OHCA. The difference in survival to hospital discharge is about 25 more people per 1000 following bystander administered continuous chest compression. When CPR was performed by professional providers, continuous chest compressions with asynchronous rescue breathing did not result in higher rates of survival compared with interrupted chest compressions plus rescue breathing CPR for non asphyxial OHCA. The results indicate slightly lower rates of survival to admission or discharge, favourable neurological outcome and return of spontaneous circulation observed following continuous chest compression. Adverse effects were slightly lower with continuous chest compression.