1. Dallas 2015 TFQO: EVREVs: Aaron Donoghue / Jonathan Duff Taskforce: EIT Teaching Compression-Only CPR

2. Dallas 2015 COI Disclosure (specific to this systematic review) Jonathan Duff (COI #69): none Aaron Donoghue (COI #333): none

3. Dallas 2015 2010 CoSTR (1) None (new worksheet)

4. Dallas 2015 C2015 PICO Population: Communities caring for patients in cardiac arrest in any setting Intervention: teaching compression-only CPR Comparison: teaching conventional CPR Outcomes: 9-Criticalneurologically intact survival at hospital discharge 7-Criticalbystander CPR rates 5-Importantbystander willingness to provide CPR

5. Dallas 2015 Inclusion/Exclusion & Articles Found List Inclusions/Exclusions Included all comparative studies (prospective and retrospective) examining the community-based teaching of CC-only CPR vs. conventional CPR Excluded studies that did not directly address the PICO question (including mannequin studies, dispatcher- assisted studies, studies not comparing the two treatments directly, outcome studies not focused on teaching, abstract-only studies, unpublished studies, letters, editorials and reviews). 2 observational studies; 1 RCT

6. Dallas 2015 2015 Proposed Treatment Recommendations There is no evidence that training bystanders in chest compression only CPR vs. conventional CPR improves or worsens outcomes. As compression-only CPR is easier to teach, we suggest that communities train bystanders in compression-only CPR for adult OHCA (weak recommendation, very low quality of evidence).

7. Dallas 2015 Risk of Bias in studies RCT bias assessment StudyYearDesign Total Patients Population Industry Funding Allocation: Generation Allocation: Concealment Blinding: Participants Blinding: Assessors Outcome: Complete Outcome: Selective Other Bias Blewer 2012RCT406OHCANoLow High Non-RCT bias asssesment StudyYearDesign Total Patients Population Industry Funding Eligibility Criteria Exposure/Outcome Confounding Follow up Bobrow 2008 Non-RCT 1515OHCANoLowHigh Low Panchal 2013Non-RCT252OHCANoLowHigh Low

8. Dallas 2015 Key data from key studies (1) Bobrow, 2008, 1158 P: Adults with OHCA of presumed cardiac etiology following community-wide educational intervention on CC-only CPR I: Bystander CC-only rates C: Bystander conventional CPR O:STHD with good neuro (CPC ≤ 2) CC-only 62/814 (13.3%) vs. conventional CPR 34/851 (5.2%); OR 1.49 (95% CI 0.97 to 2.31)

9. Dallas 2015 Key data from key studies (2) Panchal, 2013, 435 P: Adults with OHCA of presumed non-cardiac etiology following community-wide educational intervention on CC-only CPR I: Bystander CC-only rates C: Bystander conventional CPR O: STHD with good neuro (CPC ≤ 2) CC-only 1/145 (0.7%) vs. conventional CPR 2/104 (1.9%); OR 0.36 (95% CI 0.03 to 4.01)

10. Dallas 2015

11. Proposed Consensus on Science statements Outcome: Neurological Intact Survival For the critical outcomes of neurologically intact survival at hospital discharge we found two observational studies representing very low quality evidence, following downgrading for serious imprecision. (Bobrow, 2010, 1447; Panchal, 2013, 435; n=1767). Both studies reported survival to hospital discharge for adults receiving bystander CPR from the same statewide database; Bobrow et al reported on events of cardiac origin and Panchal on events of noncardiac origin. Both studies demonstrated no effect (OR 1.41 95% CI 0.92-2.14).

12. Dallas 2015 Proposed Consensus on Science statements Outcome – Bystander CPR rates For the critical outcome of bystander CPR rates, we found one observational studies representing very low quality evidence. (Bobrow, 2010, 1447) The study showed a higher proportion of bystander CPR performed using CCPR than SCPR over the study period (34.3% vs. 28.6%).

13. Dallas 2015 Proposed Consensus on Science statements Outcome – Bystander willingness to perform CPR For the important outcome of willingness to perform CPR, we found one randomized trial representing very low quality evidence, following downgrading for very serious risk of bias, very serious indirectness and serious imprecision. (Blewer, 2012, 787) Blewer et al found that family members of hospitalized adults who were given a CCPR training kit were more likely to express willingness to perform CPR (34%) than family members given an SCPR training kit (28%; OR 1.30 95% CI 0.85-1.98).

14. Dallas 2015 Draft Treatment Recommendations There is no evidence that training bystanders in chest compression only CPR vs. conventional CPR improves or worsens outcomes. As compression-only CPR is easier to teach, we suggest that communities train bystanders in compression-only CPR for adult OHCA (weak recommendation, very low quality of evidence).

15. Dallas 2015 Knowledge Gaps CCPR versus SCPR in children CCPR for adult OHCA of noncardiac origin (limited sample in Panchal et al)

16. Dallas 2015 Knowledge Gaps (eg. ETT vs BVM) Specific research required Head-to-head comparisons of teaching CC- only and conventional CPR and willingness to perform CPR Follow-up of patient outcomes and bystander CPR rates in communities with focused CC-only teaching (such as Arizona).

17. Dallas 2015 Next Steps This slide will be completed during Task Force Discussion (not EvRev) and should include: Consideration of interim statement Person responsible Due date Essential slide (one slide only). Estimated time <30 sec