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The optimal surface for delivery of CPR: An updated systematic review and meta-analysis
Maya Dewan1,2,3,4, Ethan Schachna5,6, Kathryn Eastwood5
1Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, United States.
Insights
Using a backboard slightly increases chest compression depth during cardiopulmonary resuscitation (CPR). However, changing the CPR delivery surface to the floor or a firm mattress shows minimal impact on compression depth.
Area of Science:
- Emergency Medicine
- Cardiopulmonary Resuscitation Research
Background:
- The effectiveness of cardiopulmonary resuscitation (CPR) can be influenced by the surface on which it is delivered.
- Optimal CPR delivery surface selection is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the impact of different CPR delivery surfaces (e.g., firm mattress, floor, backboard) on patient outcomes and CPR quality.
- To synthesize current evidence on CPR surface effectiveness in adults and children.
Main Methods:
- A systematic literature search was conducted across major databases (MEDLINE, Embase, Web of Science, Cochrane) for studies published since 2019.
- Included manikin randomized controlled trials due to a lack of human studies, supplemented by pre-2019 data from ILCOR.
- Data extraction, risk of bias assessment, and meta-analysis were performed using a random-effects model, with evidence certainty evaluated by GRADE.
Main Results:
- Analysis of six recent studies and eleven prior ILCOR studies, all manikin-based RCTs with low certainty of evidence.
- A meta-analysis indicated a small 2 mm increase in chest compression depth with backboard use.
- No significant difference in compression depth was observed when comparing floor or firm mattress surfaces to standard surfaces.
Conclusions:
- A backboard may offer a marginal benefit in chest compression depth during CPR.
- Transitioning to the floor or using a firm mattress does not substantially improve CPR compression depth based on current evidence.
- Further research, potentially including human studies, is needed to definitively establish the impact of CPR delivery surfaces.
Aim:
To determine the effect of CPR delivery surface (e.g. firm mattress, floor, backboard) on patient outcomes and CPR delivery.
Methods:
We searched MEDLINE, Embase, Web of Science and the Cochrane Central Register of Controlled Trials for studies published since 2019 that evaluated the effect of CPR delivery surface in adults and children on patient outcomes and CPR depth (PROSPERO CRD42023467583). We included manikin studies due to a lack of human studies. We identified pre-2019 studies from the 2020 ILCOR evaluation of this topic. Two reviewers independently screened titles/abstracts and full-text papers, extracted data and assessed risk of bias. Evidence certainty for each outcome was evaluated using GRADE methodology. Where appropriate, we pooled data in a meta-analysis, using a random-effects model.
Results:
Database searches identified 489 citations. We included six studies published since 2019. We analysed these studies together with the eleven studies included in the previous ILCOR review. All included studies were manikin randomised controlled trials. Certainty of evidence was low. Interventions including placing the patient on the floor or the use of backboard had minimal impact on achieving greater compression depth. Meta-analyses of floor versus firm hospital mattress or firm home mattress found a mean difference of 5.36 mm (95% CI -1.59 to 12.32) and 2.11 mm (95% CI -3.23 to 7.45) respectively.
Conclusion:
The use of a backboard led to a small 2 mm increase in chest compression depth in meta-analysis of multiple mannikin trials. Use of a firm mattress or transitioning to the floor did not affect chest compression depth.
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