The optimal surface for delivery of CPR: A systematic review and meta-analysis

Area of Science:

• Emergency Medicine
• Cardiopulmonary Resuscitation Research
• Clinical Trial Methodology

Background:

• The effectiveness of cardiopulmonary resuscitation (CPR) can be influenced by the surface on which it is delivered.
• Understanding the impact of different delivery surfaces is crucial for optimizing CPR quality and patient outcomes.

Purpose of the Study:

• To evaluate the effect of various CPR delivery surfaces, including mattresses and backboards, on CPR quality and patient outcomes.
• To synthesize evidence from randomized controlled trials on CPR delivery surface interventions.

Main Methods:

• A systematic literature search was conducted across major databases (Medline, Cochrane Library, Web of Science) for studies published since 2009.
• Included studies were randomized controlled trials assessing CPR delivery surfaces in adults and children, with data from prior reviews incorporated.
• Data extraction, risk of bias assessment, and meta-analysis were performed, with evidence certainty evaluated using GRADE methodology.

Main Results:

• Seven new randomized controlled trials in manikins were included, alongside four from a previous review, all demonstrating very low certainty of evidence.
• No significant improvement in chest compression depth was observed with increased mattress stiffness or when CPR was delivered on the floor.
• A marginal improvement in compression depth was noted with the use of a backboard (mean difference 3 mm).

Conclusions:

• The use of a backboard demonstrated a minor benefit in chest compression depth in manikin-based CPR trials.
• Varying mattress types or performing CPR on the floor did not yield significant changes in chest compression depth.
• Further research with higher certainty of evidence is needed to confirm these findings.