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The effect of alternative methods of cardiopulmonary resuscitation - Cough CPR, percussion pacing or precordial thump - on outcomes following cardiac arrest. A systematic review

journal contribution
posted on 2023-05-21, 04:08 authored by Dee, R, Smith, M, Rajendran, K, Perkins, GD, Smith, CM, Vaillancourt, C, Suzanne AvisSuzanne Avis, Brooks, S, Castren, M, Chung, SP, Considine, J, Escalante, R, Han, LW, Hatanaka, T, Hazinski, MF, Hung, K, Kudenchuk, P, Morley, P, Ng, K-C, Nishiyama, C, Semeraro, F, Smyth, M, Vaillancourt, V

Background: Cardiopulmonary resuscitation (CPR) improves cardiac arrest survival. Cough CPR, percussion pacing and precordial thump have been reported as alternative CPR techniques. We aimed to summarise in a systematic review the effectiveness of these alternative CPR techniques.

Methods: We searched Ovid MEDLINE, EMBASE and the Cochrane Library on 24/08/2020. We included randomised controlled trials, observational studies and case series with five or more patients. Two reviewers independently reviewed title and abstracts to identify studies for full-text review, and reviewed bibliographies and 'related articles' (using PubMed) of full-texts for further eligible studies. We extracted data and performed risk-of-bias assessments on studies included in the systematic review. We summarised data in a narrative synthesis, and used GRADE to assess evidence certainty.

Results: We included 23 studies (cough CPR n = 4, percussion pacing n = 4, precordial thump n = 16; one study studied two interventions). Only two (both precordial thump) had a comparator group ('standard' CPR). For all techniques evidence certainty was very low. Available evidence suggests that precordial thump does not improve survival to hospital discharge in out-of-hospital cardiac arrest. The review did not find evidence that cough CPR or percussion pacing improve clinical outcomes following cardiac arrest.

Conclusion: Cough CPR, percussion pacing and precordial thump should not be routinely used in established cardiac arrest. In specific inpatient, monitored settings cough CPR (in conscious patients) or percussion pacing may be attempted at the onset of a potential lethal arrhythmia. These must not delay standard CPR efforts in those who lose cardiac output.

History

Publication title

Resuscitation

Volume

162

Pagination

73-81

ISSN

0300-9572

Department/School

School of Paramedicine

Publisher

Elsevier Sci Ireland Ltd

Place of publication

Customer Relations Manager, Bay 15, Shannon Industrial Estate Co, Clare, Ireland

Rights statement

© 2021 Elsevier B.V. All rights reserved.

Repository Status

  • Restricted

Socio-economic Objectives

Treatment of human diseases and conditions

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