Does delivering chest compressions to patients who are not in cardiac arrest cause unintentional injury? A systematic review

Background

Chest compressions are life-saving in cardiac arrest but concern by layperson of causing unintentional injury to patients who are not in cardiac arrest may limit provision and therefore delay initiation when required.

Aim

To perform a systematic review of the evidence to identify if; among patients not in cardiac arrest outside of a hospital, does provision of chest compressions from a layperson, compared to no use of chest compressions, worsen outcomes.

Method

We searched Medline (Ovid), Web of Science Core Collection (clarivate) and Cinahl (Ebsco). Outcomes included survival with favourable neurological/functional outcome at discharge or 30 days; unintentional injury (e.g. rib fracture, bleeding); risk of injury (e.g. aspiration). ROBINS-I was used to assess for risk of bias. Grading of Recommendations, Assessment, Development and Evaluation methodology was used to determine the certainty of evidence. (PROSPERO registration number: CRD42023476764).

Results

From 7832 screened references, five observational studies were included, totaling 1031 patients. No deaths directly attributable to chest compressions were reported, but 61 (6 %) died before discharge due to underlying conditions. In total, 9 (<1%) experienced injuries, including rib fractures and different internal bleedings, and 24 (2 %) reported symptoms such as chest pain. Evidence was of very low certainty due to risk of bias and imprecision.

Conclusion

Patients initially receiving chest compressions by a layperson and who later were determined by health care professionals to not be in cardiac arrest rarely had injuries from chest compressions.