Continuous compression with asynchronous ventilation improves CPR prognosis? A meta-analysis from human and animal studies - 13/01/23
, Yangyang Tang a, bAbstract |
Background |
The cardiopulmonary resuscitation (CPR) compression to ventilation strategy remains controversial. We conducted a meta-analysis to compare the outcomes between continuous chest compressions CPR with asynchronous ventilation (CCC-CPR) and interrupted chest compressions CPR with synchronous ventilation (ICC-CPR) in cardiac arrest.
Methods |
PubMed, Web of Science, Embase, MEDLINE (Ovid/LWW) and the Cochrane Libraries were searched up from inception to July 31, 2022. Human and animal studies comparing CCC-CPR versus ICC-CPR were included. Outcome variables were return of spontaneous circulation (ROSC), time to ROSC, survival to discharge, 1-month survival, survival at 4 h, good neurological function, mean arterial pressure (MAP) and other clinical parameters. Jadad Scale and Newcastle-Ottawa Scale were used to assess the study quality and risk of bias.
Results |
The systematic search identified eight studies on humans and twelve studies on animal trials. There were no significant differences in ROSC (odd ratios [OR] 1.07; 95% confidence interval [CI]: 0.86–1.32; P = 0.55), survival to hospital discharge (OR 1.04; 95%CI 0.77–1.42; P = 0.79), 1-month survival (OR 1.07; 95%CI 0.84–1.36; P = 0.57), and good neurological outcome (OR 0.92; 95%CI 0.84–1.01, P = 0.09) between CCC-CPR and ICC-CPR in human studies. In animal trials, CCC-CPR had significantly higher rate of ROSC (OR = 1.81; 95% CI: 0.94–3.49; P = 0.07), survival at 4 h (OR 2.57; 95% CI: 1.16–5.72; P = 0.02) and MAP (mean difference [MD] 0.79, 95% CI: 0.04–1.53; P = 0.04), even though no significant differences in ROSC time, arterial potential of hydrogen (pH) and partial tension of carbon dioxide (PaCO2).
Conclusion |
CCC-CPR did not show superiority in human outcomes compared with ICC-CPR, but its effect value was significantly increased in animal experiments. We should take the positive outcomes from animals and apply them to human models, and more physiological mechanisms need to be confirmed in CPR patients with different compression-ventilation strategies to improve the prognosis of cardiac arrest.
Le texte complet de cet article est disponible en PDF.Keywords : Cardiopulmonary resuscitation, Cardiac arrest, Continuous chest compression, Interrupted chest compression, Asynchronous ventilation, Synchronous ventilation
Plan
Vol 64
P. 26-36 - février 2023 Retour au numéro
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