title: Cardiopulmonary resuscitation quality and patient survival outcome in cardiac arrest: A systematic review and meta-analysis.
abstract: OBJECTIVE
  To conduct a systematic review and meta-analysis to determine whether cardiopulmonary resuscitation (CPR) quality, as indicated by parameters such as chest compression depth, compression rate and compression fraction, is associated with patient survival from cardiac arrest.
  
  
  METHODS
  Five databases were searched (MEDLINE, Embase, CINAHL, Scopus and Cochrane) as well as the grey literature (MedNar). To satisfy inclusion criteria, studies had to document human cases of in- or out-of hospital cardiac arrest where CPR quality had been recorded using an automated device and linked to patient survival. Where indicated (I(2)<75%), meta-analysis was undertaken to examine the relationship between individual CPR quality parameters and either survival to hospital discharge (STHD) or return of spontaneous circulation (ROSC).
  
  
  RESULTS
  Database searching yielded 8,842 unique citations, resulting in the inclusion of 22 relevant articles. Thirteen were included in the meta-analysis. Chest compression depth was significantly associated with STHD (mean difference (MD) between survivors and non-survivors 2.59 mm, 95% CI: 0.71, 4.47); and with ROSC (MD 0.99 mm, 95% CI: 0.04, 1.93). Within the range of approximately 100-120 compressions per minute (cpm), compression rate was significantly associated with STHD; survivors demonstrated a lower mean compression rate than non-survivors (MD -1.17 cpm, 95% CI: -2.21, -0.14). Compression fraction could not be examined by meta-analysis due to high heterogeneity, however a higher fraction appeared to be associated with survival in cases with a shockable initial rhythm.
  
  
  CONCLUSIONS
  Chest compression depth and rate were associated with survival outcomes. More studies with consistent reporting of data are required for other quality parameters.
authors.affiliation: Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, Australia. Electronic address: milena.talikowska@postgrad.curtin.edu.au.
authors.forename: Milena
authors.initials: M
authors.lastname: Talikowska
authors.affiliation: Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, Australia.
authors.forename: Hideo
authors.initials: H
authors.lastname: Tohira
authors.affiliation: Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, Australia; St. John Ambulance, Western Australia, Belmont, WA, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
authors.forename: Judith
authors.initials: J
authors.lastname: Finn
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D014943:Global Health; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D019984:Quality Indicators, Health Care; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: Cardiac arrest; Cardiopulmonary resuscitation; Quality; Survival