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COCHRANE CORNER By David Barrett, PhD, RN

Editor’s note: This is a summary of a nursing care–related systematic review from


the Cochrane Library. For more information, see http://nursingcare.cochrane.org.

Continuous vs. Interrupted Chest


Compressions for Cardiac Arrest
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REVIEW QUESTION In the three untrained bystander–CPR studies


In patients with non-asphyxial out-of-hospital cardiac (n = 3,031), the pooled data on survival to discharge
arrest (OHCA), which method of CPR—continuous showed better survival for the intervention group
or interrupted chest compressions—will better enable than the control group (14% versus 11.6%). In one
survival to hospital admission or discharge? trial (n = 520) there was no significant difference in
survival to hospital admission between the two groups.
TYPE OF REVIEW Similarly, another trial (n = 1,286) reported no signifi-
A systematic review of four randomized controlled cant differences in neurologic outcomes between the
trials (RCTs). groups.
In the one EMS professional–CPR study (n =
RELEVANCE FOR NURSING 23,711), participants received either the intervention
OHCA affects approximately 700,000 people annu- (continuous chest compressions [100 per minute] and
ally in the United States and Europe. It is estimated asynchronous rescue breathing [10 per minute]) or the
that only about one in 10 patients suffering OHCA control CPR (interrupted chest compressions with
will survive to hospital discharge. Early, high-quality pauses for rescue breathing at a 30:2 ratio). Compared
CPR is associated with improved survival rates. For with the control group, the intervention group had
many years, conventional CPR required chest com- a not significantly lower survival-to-discharge rate
pressions to be interrupted for rescue breaths—most (9% versus 9.7%) and a significantly lower survival-
recently at a ratio of 30 compressions to two breaths. to-admission rate (24.6% versus 25.9%). There were
Continuous chest compressions, on the other hand, no significant differences in rates of ROSC or in
are characterized by rescue breaths given either asyn- neurologic outcomes.
chronously or not at all.
BEST PRACTICE RECOMMENDATIONS
CHARACTERISTICS OF THE EVIDENCE When delivered by untrained bystanders receiving in-
This review sought to identify differences in patient struction over the telephone, CPR consisting of contin-
outcomes between continuous chest compressions uous compressions with no rescue breaths is associated
with or without rescue breathing (intervention group) with higher rates of survival to hospital discharge than
and chest compressions interrupted by rescue breath- conventional, interrupted chest compressions and res-
ing (control group), specifically in non-asphyxial cue breathing. In the case of CPR performed by EMS
OHCA. Non-asphyxial cardiac arrest is related to professionals, continuous chest compressions did not
abnormalities in cardiac function, unlike asphyxial yield better outcomes.
cardiac arrest, which is related to reduced oxygen
levels (due to choking or drowning, for example). RESEARCH RECOMMENDATIONS
Four studies were included in the review: three RCTs More research into this issue is required, particularly
and one cluster RCT, for a total of 26,742 patients. on the impact of increased automatic external defi-
In three studies, CPR was delivered by untrained brillator availability and the use of continuous chest
bystanders listening to emergency medical service compressions in pediatric cardiac arrest. ▼
(EMS) instructions by telephone; in the remaining
David Barrett is academic manager, Faculty of Health Sciences,
study, CPR was provided by EMS professionals. University of Hull, Hull, United Kingdom, and a member of the
Primary outcomes were survival to hospital ad- Cochrane Nursing Care Field.
mission with spontaneous circulation and a mea- SOURCE DOCUMENT
surable blood pressure, and survival to hospital Zhan L, et al. Continuous chest compression versus inter-
discharge. Secondary outcomes included return of rupted chest compression for cardiopulmonary resuscitation
spontaneous circulation (ROSC) and neurologic of non-asphyxial out-of-hospital cardiac arrest. Cochrane
Database Syst Rev 2017;3:CD010134.
outcomes.

68 AJN ▼ March 2018 ▼ Vol. 118, No. 3 ajnonline.com