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 patients with non-asphyxial out-of-hospital cardiac
arrest (OHCA), which method of CPR—continuous
or interrupted chest compressions—will better enable
survival to hospital admission or discharge?
TYPE OF REVIEW
A systematic review of four randomized controlled
trials (RCTs).
RELEVANCE FOR NURSING
OHCA affects approximately 700,000 people annu-
ally in the United States and Europe. It is estimated
that only about one in 10 patients suffering OHCA
will survive to hospital discharge. Early, high-quality
CPR is associated with improved survival rates. For
many years, conventional CPR required chest com-
pressions to be interrupted for rescue breaths—most
recently at a ratio of 30 compressions to two breaths.
Continuous chest compressions, on the other hand,
are characterized by rescue breaths given either asyn-
chronously or not at all.
CHARACTERISTICS OF THE EVIDENCE
This review sought to identify differences in patient
outcomes between continuous chest compressions
with or without rescue breathing (intervention group)
and chest compressions interrupted by rescue breath-
ing (control group), specifically in non-asphyxial
OHCA. Non-asphyxial cardiac arrest is related to
abnormalities in cardiac function, unlike asphyxial
cardiac arrest, which is related to reduced oxygen
levels (due to choking or drowning, for example).
Four studies were included in the review: three RCTs
and one cluster RCT, for a total of 26,742 patients.
In three studies, CPR was delivered by untrained
bystanders listening to emergency medical service
(EMS) instructions by telephone; in the remaining
study, CPR was provided by EMS professionals.
Primary outcomes were survival to hospital ad-
mission with spontaneous circulation and a mea-
surable blood pressure, and survival to hospital
discharge. Secondary outcomes included return of
spontaneous circulation (ROSC) and neurologic
outcomes.
68 AJN ▼ March 2018 ▼ Vol. 118, No. 3 ajnonline.com
In the three untrained bystander–CPR studies
(n = 3,031), the pooled data on survival to discharge
showed better survival for the intervention group
than the control group (14% versus 11.6%). In one
trial (n = 520) there was no significant difference in
survival to hospital admission between the two groups.
Similarly, another trial (n = 1,286) reported no signifi-
cant differences in neurologic outcomes between the
groups.
In the one EMS professional–CPR study (n =
23,711), participants received either the intervention
(continuous chest compressions [100 per minute] and
asynchronous rescue breathing [10 per minute]) or the
control CPR (interrupted chest compressions with
pauses for rescue breathing at a 30:2 ratio). Compared
with the control group, the intervention group had
a not significantly lower survival-to-discharge rate
(9% versus 9.7%) and a significantly lower survival-
to-admission rate (24.6% versus 25.9%). There were
no significant differences in rates of ROSC or in
neurologic outcomes.
BEST PRACTICE RECOMMENDATIONS
When delivered by untrained bystanders receiving in-
struction over the telephone, CPR consisting of contin-
uous compressions with no rescue breaths is associated
with higher rates of survival to hospital discharge than
conventional, interrupted chest compressions and res-
cue breathing. In the case of CPR performed by EMS
professionals, continuous chest compressions did not
yield better outcomes.
RESEARCH RECOMMENDATIONS
More research into this issue is required, particularly
on the impact of increased automatic external defi-
brillator availability and the use of continuous chest
compressions in pediatric cardiac arrest. ▼
David Barrett is academic manager, Faculty of Health Sciences,
University of Hull, Hull, United Kingdom, and a member of the
Cochrane Nursing Care Field.
SOURCE DOCUMENT
Zhan L, et al. Continuous chest compression versus inter-
rupted chest compression for cardiopulmonary resuscitation
of non-asphyxial out-of-hospital cardiac arrest. Cochrane
Database Syst Rev 2017;3:CD010134.