Active chest compression‐decompression for cardiopulmonary resuscitation

Carmelo Lafuente‐Lafuente; María Melero‐Bascones

doi:10.1002/14651858.CD002751.pub2

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Analysis 1.1

Comparison 1 Out‐of‐hospital cardiac arrests, Outcome 1 Immediate mortality.

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Analysis 1.2

Comparison 1 Out‐of‐hospital cardiac arrests, Outcome 2 Mortality at hospital discharge.

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Analysis 1.3

Comparison 1 Out‐of‐hospital cardiac arrests, Outcome 3 Neurological impairment in survivors.

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Analysis 1.4

Comparison 1 Out‐of‐hospital cardiac arrests, Outcome 4 Complications.

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Analysis 2.1

Comparison 2 In‐hospital cardiac arrests, Outcome 1 Immediate mortality.

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Analysis 2.2

Comparison 2 In‐hospital cardiac arrests, Outcome 2 Mortality at hospital discharge.

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Analysis 2.3

Comparison 2 In‐hospital cardiac arrests, Outcome 3 Neurological impairment in survivors.

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Analysis 2.4

Comparison 2 In‐hospital cardiac arrests, Outcome 4 Complications.

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Analysis 3.1

Comparison 3 Subgroup analysis: Physician in first responding team or only paramedics, Outcome 1 Immediate mortality.

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Analysis 3.2

Comparison 3 Subgroup analysis: Physician in first responding team or only paramedics, Outcome 2 Mortality at hospital discharge.

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Analysis 3.3

Comparison 3 Subgroup analysis: Physician in first responding team or only paramedics, Outcome 3 Neurological impairment in survivors (any severity).

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Analysis 4.1

Comparison 4 Sensitivity analysis: Best quality studies, Outcome 1 Immediate mortality.

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Analysis 4.2

Comparison 4 Sensitivity analysis: Best quality studies, Outcome 2 Mortality at hospital discharge.

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Analysis 4.3

Comparison 4 Sensitivity analysis: Best quality studies, Outcome 3 Neurological impairment in survivors (any severity).

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Analysis 5.1

Comparison 5 Sensitivity analysis: Largest (n > 500) studies, Outcome 1 Immediate mortality.

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Analysis 5.2

Comparison 5 Sensitivity analysis: Largest (n > 500) studies, Outcome 2 Mortality at hospital discharge.

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Analysis 5.3

Comparison 5 Sensitivity analysis: Largest (n > 500) studies, Outcome 3 Neurological impairment in survivors (any severity).

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Comparison 1. Out‐of‐hospital cardiac arrests

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Immediate mortality Show forest plot	10	4162	Risk Ratio (M‐H, Random, 95% CI)	0.98 [0.94, 1.03]

2 Mortality at hospital discharge Show forest plot	9	3412	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.98, 1.01]

3 Neurological impairment in survivors Show forest plot	5	358	Risk Ratio (M‐H, Fixed, 95% CI)	1.74 [1.06, 2.83]

3.1 Moderate neurological impairment	4	107	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.34, 2.79]
3.2 Severe neurological impairment	4	107	Risk Ratio (M‐H, Fixed, 95% CI)	3.11 [0.98, 9.83]
3.3 Any neurological impairment (any severity)	5	144	Risk Ratio (M‐H, Fixed, 95% CI)	1.71 [0.90, 3.25]
4 Complications Show forest plot	7	3032	Risk Ratio (M‐H, Fixed, 95% CI)	1.09 [0.86, 1.38]

Comparison 1. Out‐of‐hospital cardiac arrests

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Comparison 2. In‐hospital cardiac arrests

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Immediate mortality Show forest plot	2	826	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.88, 1.08]

2 Mortality at hospital discharge Show forest plot	2	826	Risk Ratio (M‐H, Fixed, 95% CI)	1.00 [0.95, 1.05]

3 Neurological impairment in survivors Show forest plot	2	279	Risk Ratio (M‐H, Fixed, 95% CI)	1.19 [0.63, 2.25]

3.1 Moderate neurologic impairment	2	93	Risk Ratio (M‐H, Fixed, 95% CI)	0.5 [0.10, 2.58]
3.2 Severe neurologic impairment	2	93	Risk Ratio (M‐H, Fixed, 95% CI)	1.95 [0.59, 6.50]
3.3 Any neurological impairment (any severity)	2	93	Risk Ratio (M‐H, Fixed, 95% CI)	1.19 [0.50, 2.86]
4 Complications Show forest plot	1	773	Risk Ratio (M‐H, Fixed, 95% CI)	0.97 [0.49, 1.93]

Comparison 2. In‐hospital cardiac arrests

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Comparison 3. Subgroup analysis: Physician in first responding team or only paramedics

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Immediate mortality Show forest plot	10	4162	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.94, 1.01]

1.1 Physician in first responding team	5	1487	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.89, 1.04]
1.2 Only paramedics in first responding team	5	2675	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.95, 1.02]
2 Mortality at hospital discharge Show forest plot	9	3412	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.98, 1.01]

2.1 Physician in first responding team	4	737	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.94, 1.04]
2.2 Only paramedics in first responding team	5	2675	Risk Ratio (M‐H, Fixed, 95% CI)	1.00 [0.98, 1.01]
3 Neurological impairment in survivors (any severity) Show forest plot	5	144	Risk Ratio (M‐H, Fixed, 95% CI)	1.71 [0.90, 3.25]

3.1 Physician in first responding team	2	44	Risk Ratio (M‐H, Fixed, 95% CI)	1.07 [0.41, 2.80]
3.2 Only paramedics in first responding team	3	100	Risk Ratio (M‐H, Fixed, 95% CI)	2.19 [0.93, 5.13]

Comparison 3. Subgroup analysis: Physician in first responding team or only paramedics

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Comparison 4. Sensitivity analysis: Best quality studies

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Immediate mortality Show forest plot	12	4988	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.95, 1.01]

1.1 Allocation concealment adequate	5	2460	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.96, 1.06]
1.2 Allocation concealment unclear	1	61	Risk Ratio (M‐H, Fixed, 95% CI)	1.13 [0.77, 1.65]
1.3 Allocation concealment inadequate	6	2467	Risk Ratio (M‐H, Fixed, 95% CI)	0.94 [0.90, 0.99]
2 Mortality at hospital discharge Show forest plot	11	4238	Risk Ratio (M‐H, Fixed, 95% CI)	1.00 [0.98, 1.01]

2.1 Allocation concealment adequate	5	2460	Risk Ratio (M‐H, Fixed, 95% CI)	1.00 [0.97, 1.02]
2.2 Allocation concealment unclear	1	61	Risk Ratio (M‐H, Fixed, 95% CI)	1.04 [0.87, 1.25]
2.3 Allocation concealment inadequate	5	1717	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.97, 1.02]
3 Neurological impairment in survivors (any severity) Show forest plot	7	237	Risk Ratio (M‐H, Fixed, 95% CI)	1.50 [0.89, 2.51]

3.1 Allocation concealment adequate	3	163	Risk Ratio (M‐H, Fixed, 95% CI)	1.45 [0.75, 2.79]
3.2 Allocation concealment unclear	1	7	Risk Ratio (M‐H, Fixed, 95% CI)	0.89 [0.33, 2.37]
3.3 Allocation concealment inadequate	3	67	Risk Ratio (M‐H, Fixed, 95% CI)	2.09 [0.67, 6.54]

Comparison 4. Sensitivity analysis: Best quality studies

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Comparison 5. Sensitivity analysis: Largest (n > 500) studies

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Immediate mortality Show forest plot	5	3815	Risk Ratio (M‐H, Fixed, 95% CI)	0.97 [0.93, 1.00]

2 Mortality at hospital discharge Show forest plot	4	3065	Risk Ratio (M‐H, Fixed, 95% CI)	1.00 [0.98, 1.02]

3 Neurological impairment in survivors (any severity) Show forest plot	3	159	Risk Ratio (M‐H, Fixed, 95% CI)	1.60 [0.81, 3.16]

Comparison 5. Sensitivity analysis: Largest (n > 500) studies

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