Ashoor HM, Lillie E, Zarin W, et al. Effectiveness of different compression-to-ventilation methods for cardiopulmonary resuscitation: A systematic review. Resuscitation. 2017 Sep;118:112-125. doi: 10.1016/j.resuscitation.2017.05.032. Epub 2017 Jun 2.
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AIM: To compare the effectiveness of different compression-to-ventilation methods during cardiopulmonary resuscitation (CPR) in patients with cardiac arrest.

METHODS: We searched MEDLINE and Cochrane Central Register of Controlled Trials from inception until January 2016. We included experimental, quasi-experimental, and observational studies that compared different chest compression-to-ventilation ratios during CPR for all patients and assessed at least one of the following outcomes: favourable neurological outcomes, survival, return of spontaneous circulation (ROSC), and quality of life. Two reviewers independently screened literature search results, abstracted data, and appraised the risk of bias. Random-effects meta-analyses were conducted separately for randomised and non-randomised studies, as well as study characteristics, such as CPR provider.

RESULTS: After screening 5703 titles and abstracts and 229 full-text articles, we included 41 studies, of which 13 were companion reports. For adults receiving bystander or dispatcher-instructed CPR, no significant differences were observed across all comparisons and outcomes. Significantly less adults receiving bystander-initiated or plus dispatcher-instructed compression-only CPR experienced favourable neurological outcomes, survival, and ROSC compared to CPR 30:2 (compression-to-ventilation) in un-adjusted analyses in a large cohort study. Evidence from emergency medical service (EMS) CPR providers showed significantly more adults receiving CPR 30:2 experiencing improved favourable neurological outcomes and survival versus those receiving CPR 15:2. Significantly more children receiving CPR 15:2 or 30:2 experienced favourable neurological outcomes, survival, and greater ROSC compared to compression-only CPR. However, for children <1 years of age, no significant differences were observed between CPR 15:2 or 30:2 and compression-only CPR.

CONCLUSIONS: Our results demonstrated that for adults, CPR 30:2 is associated with better survival and favourable neurological outcomes when compared to CPR 15:2. For children, more patients receiving CPR with either 15:2 or 30:2 compression-to ventilation ratio experienced favourable neurological function, survival, and ROSC when compared to CO-CPR for children of all ages, but for children <1years of age, no statistically significant differences were observed.

Comments from MORE raters

Physician rater

Important confirmation of existing practice.

Physician rater

This is a large systematic review and meta-analysis with excellent methods showing that the current CPR guidelines are evidence-based. Adult CPR 30:2, paediatric CPR 30:2 if a single rescuer, and 15:2 with 2 rescuers.

Physician rater

Very useful indeed!

Physician rater

A systematic review of studies comparing one or more modes of CPR provision (compression-only vs 15:2 vs 30:2 ratios of compressions to breaths) in adults and children. Like previous similar analyses (Cochrane among others), for adults there appear to be better outcomes with a higher ratio of compressions:breaths (i.e. 30:2 beats 15:2), although continuous CPR or compression - only CPR have been reported to improve outcomes in some studies. In children, 15:2 appears to be superior in this analysis, which is in keeping with the understanding that a greater number of pediatric arrests are primarily respiratory in etiology.
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