Compression-only CPR best for out-of-hospital cardiac arrest

Compression-only CPR best for out-of-hospital cardiac arrest
Compression-only CPR best for out-of-hospital cardiac arrest

HealthDay News -- Compression-only cardiopulmonary resuscitation (CPR), without mouth-to-mouth rescue breathing, is associated with higher survival and more favorable neurological outcomes than conventional CPR for patients experiencing out-of-hospital cardiac arrest.

When bystanders performed chest compression-only CPR and used a public-access automated external defibrillator (AED), 40.7% of out-of-hospital cases survived at least a month without needing assistance in daily living, Taku Iwami, MD, PhD, of the Kyoto University Health Service in Kyoto, Japan, and colleagues reported in Circulation.

Among patients administered conventional CPR and a defibrillator shock, that rate was 32.9%, the researchers found.

"Compression-only CPR is the most likely scenario in which lay rescuers can witness a sudden collapse and use public-access AEDs," the researchers wrote.

Although chest compressions alternating with rescue breathing remain the standard for trained rescuers, 2010 recommendations state that untrained bystanders should only administer chest compressions due to the difficulty of performing rescue breathing, and the likelihood that it could interfere with chest compressions.

Iwami and colleagues performed a prospective observational study involving 1,376 patients who experienced out-of-hospital cardiac arrests and received CPR and AED shocks, as recorded prospectively in the All-Japan Utstein Registry of the Fire and Disaster Management Agency from 2005 through 2009.

The researchers found that 36.8% of patients received chest compression-only CPR and 63.2% received conventional CPR with compressions and rescue breathing during the study period.

Outcomes were better after chest compression-only CPR than when it involved rescue breathing for several key endpoints:

  • Prehospital return of spontaneous circulation (50% vs. 40%; P<0.001)
  • One-month survival, based on follow-up by emergency responders (46% vs. 40%; P=0.018)
  • Survival to at least 1 month with no more than moderate cerebral disability (41% vs. 33%, P=0.003)
There was a significantly higher rate of neurologically favorable one-month survival among the chest compression-only CPR group compared with the conventional CPR group -- 40.7% vs. 32.9%; adjusted odds ratio, 1.33).

Conventional CPR with rescue breathing is still recommended for children, since their cardiac arrests are less likely to be of cardiac origins, the researchers noted.

They suggested chest compression-only training programs as the standard for most people, and conventional CPR training as an option for medical professionals, lifeguards, school teachers and families with children.

References
  1. Iwami T et al. Circulation 2012; 126; DOI: 10.1161/CIRCULATIONAHA.112.109504.
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