The optimal surface for delivery of CPR: An updated systematic review and meta-analysis

Maya Dewan; Ethan Schachna; Kathryn Eastwood; Gavin Perkins; Janet Bray; International Liaison Committee on Resuscitation Basic Life Support Task Force

doi:10.1016/j.resplu.2024.100718

The optimal surface for delivery of CPR: An updated systematic review and meta-analysis

Resusc Plus. 2024 Jul 20:19:100718. doi: 10.1016/j.resplu.2024.100718. eCollection 2024 Sep.

Authors

Maya Dewan^{1

2

3

4}, Ethan Schachna^{5

6}, Kathryn Eastwood⁵, Gavin Perkins^{7

8}, Janet Bray^{5

6}; International Liaison Committee on Resuscitation Basic Life Support Task Force

Affiliations

¹ Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, United States.
² Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
³ Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
⁴ James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
⁵ School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
⁶ Curtin School of Nursing, Curtin University, Perth, Australia.
⁷ MERIT and Enhanced Care Team, West Midlands Ambulance Service NHS University Foundation Trust, Oldbury, UK.
⁸ Warwick Medical School, University of Warwick, Coventry, UK.

Abstract

Aim: To determine the effect of CPR delivery surface (e.g. firm mattress, floor, backboard) on patient outcomes and CPR delivery.

Methods: We searched MEDLINE, Embase, Web of Science and the Cochrane Central Register of Controlled Trials for studies published since 2019 that evaluated the effect of CPR delivery surface in adults and children on patient outcomes and CPR depth (PROSPERO CRD42023467583). We included manikin studies due to a lack of human studies. We identified pre-2019 studies from the 2020 ILCOR evaluation of this topic. Two reviewers independently screened titles/abstracts and full-text papers, extracted data and assessed risk of bias. Evidence certainty for each outcome was evaluated using GRADE methodology. Where appropriate, we pooled data in a meta-analysis, using a random-effects model.

Results: Database searches identified 489 citations. We included six studies published since 2019. We analysed these studies together with the eleven studies included in the previous ILCOR review. All included studies were manikin randomised controlled trials. Certainty of evidence was low. Interventions including placing the patient on the floor or the use of backboard had minimal impact on achieving greater compression depth. Meta-analyses of floor versus firm hospital mattress or firm home mattress found a mean difference of 5.36 mm (95% CI -1.59 to 12.32) and 2.11 mm (95% CI -3.23 to 7.45) respectively.

Conclusion: The use of a backboard led to a small 2 mm increase in chest compression depth in meta-analysis of multiple mannikin trials. Use of a firm mattress or transitioning to the floor did not affect chest compression depth.

Keywords: Backboard; Cardiac arrest; Chest Compressions; Mattress; Systematic review.

Publication types

Review