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Push hard, push fast, if you're downtown: a citation review of urban-centrism in American and European basic life support guidelines.

Orkin AM - Scand J Trauma Resusc Emerg Med (2013)

Bottom Line: The cited studies suggest either no survival benefit or harm arising from compression-only CPR in settings with extended ambulance response times.The evidentiary basis for 2010 AHA and ERC bystander CPR guidelines does not attend to settings without rapid ambulance response times or dispatch services.Standardized bystander CPR guidelines may require adaptation or reconsideration in these settings.

View Article: PubMed Central - HTML - PubMed

Affiliation: Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5S 3M2, Canada. aaron.orkin@mail.utoronto.ca

ABSTRACT
Bystander cardiopulmonary resuscitation (CPR) improves out-of-hospital cardiac arrest (OHCA) survival. In settings with prolonged ambulance response times, skilled bystanders may be even more crucial. In 2010, American Heart Association (AHA) and European Resuscitation Council (ERC) introduced compression-only CPR as an alternative to conventional bystander CPR under some circumstances. The purpose of this citation review and document analysis is to determine whether the evidentiary basis for 2010 AHA and ERC guidelines attends to settings with prolonged ambulance response times or no formal ambulance dispatch services. Primary and secondary citations referring to epidemiological research comparing adult OHCA survival based on the type of bystander CPR were included in the analysis. Details extracted from the citations included a study description and primary outcome measure, the geographic location in which the study occurred, EMS response times, the role of dispatchers, and main findings and summary statistics regarding rates of survival among patients receiving no CPR, conventional CPR or compression-only CPR. The inclusion criteria were met by 10 studies. 9 studies took place exclusively in urban settings. Ambulance dispatchers played an integral role in 7 studies. The cited studies suggest either no survival benefit or harm arising from compression-only CPR in settings with extended ambulance response times. The evidentiary basis for 2010 AHA and ERC bystander CPR guidelines does not attend to settings without rapid ambulance response times or dispatch services. Standardized bystander CPR guidelines may require adaptation or reconsideration in these settings.

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Related in: MedlinePlus

Schematic of citation search.
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Figure 2: Schematic of citation search.

Mentions: The 3 review citations were identified as review papers on compression-only CPR or BLS guidelines (2 citations from the AHA [21,22] and 1 citation from the ERC [23]). The structure of these papers permitted immediate identification of citations related to adult OHCA survival based on compression-only CPR vs. other resuscitative manoeuvres, through a published table or literature review. These tables included 12 citations not previously identified through the primary search of AHA and ERC guideline citations. Of the 12 papers cited related to adult OHCA survival based on the type of CPR performed, 7 were excluded because they concerned CPR performed by health professionals and 1 was excluded because it did not pertain to compression-only CPR. The remaining four original studies were included for data abstraction [24-27]. Figure 2 provides a schematic of the citation search process. Additional file 1 provides an annotated version of Figure 2 with a list of all included and excluded citations.


Push hard, push fast, if you're downtown: a citation review of urban-centrism in American and European basic life support guidelines.

Orkin AM - Scand J Trauma Resusc Emerg Med (2013)

Schematic of citation search.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3643884&req=5

Figure 2: Schematic of citation search.
Mentions: The 3 review citations were identified as review papers on compression-only CPR or BLS guidelines (2 citations from the AHA [21,22] and 1 citation from the ERC [23]). The structure of these papers permitted immediate identification of citations related to adult OHCA survival based on compression-only CPR vs. other resuscitative manoeuvres, through a published table or literature review. These tables included 12 citations not previously identified through the primary search of AHA and ERC guideline citations. Of the 12 papers cited related to adult OHCA survival based on the type of CPR performed, 7 were excluded because they concerned CPR performed by health professionals and 1 was excluded because it did not pertain to compression-only CPR. The remaining four original studies were included for data abstraction [24-27]. Figure 2 provides a schematic of the citation search process. Additional file 1 provides an annotated version of Figure 2 with a list of all included and excluded citations.

Bottom Line: The cited studies suggest either no survival benefit or harm arising from compression-only CPR in settings with extended ambulance response times.The evidentiary basis for 2010 AHA and ERC bystander CPR guidelines does not attend to settings without rapid ambulance response times or dispatch services.Standardized bystander CPR guidelines may require adaptation or reconsideration in these settings.

View Article: PubMed Central - HTML - PubMed

Affiliation: Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5S 3M2, Canada. aaron.orkin@mail.utoronto.ca

ABSTRACT
Bystander cardiopulmonary resuscitation (CPR) improves out-of-hospital cardiac arrest (OHCA) survival. In settings with prolonged ambulance response times, skilled bystanders may be even more crucial. In 2010, American Heart Association (AHA) and European Resuscitation Council (ERC) introduced compression-only CPR as an alternative to conventional bystander CPR under some circumstances. The purpose of this citation review and document analysis is to determine whether the evidentiary basis for 2010 AHA and ERC guidelines attends to settings with prolonged ambulance response times or no formal ambulance dispatch services. Primary and secondary citations referring to epidemiological research comparing adult OHCA survival based on the type of bystander CPR were included in the analysis. Details extracted from the citations included a study description and primary outcome measure, the geographic location in which the study occurred, EMS response times, the role of dispatchers, and main findings and summary statistics regarding rates of survival among patients receiving no CPR, conventional CPR or compression-only CPR. The inclusion criteria were met by 10 studies. 9 studies took place exclusively in urban settings. Ambulance dispatchers played an integral role in 7 studies. The cited studies suggest either no survival benefit or harm arising from compression-only CPR in settings with extended ambulance response times. The evidentiary basis for 2010 AHA and ERC bystander CPR guidelines does not attend to settings without rapid ambulance response times or dispatch services. Standardized bystander CPR guidelines may require adaptation or reconsideration in these settings.

Show MeSH
Related in: MedlinePlus