Chest Compression Alone CPR Is Associated With Better Long-Term Survival Compared to Standard CPR

Study Questions:

Does omission of rescue breaths during bystander cardiopulmonary resuscitation (CPR) affect long-term outcomes compared to conventional CPR?

Methods:

Long-term survival was analyzed in 2,496 patients (median age 66 years) with out-of-hospital cardiac arrest (OHCA) who were the subjects of two randomized trials (DART and TANGO). Bystanders were instructed by dispatchers to perform either uninterrupted chest compressions (n = 1,243) or chest compressions plus 2 rescue breaths every 15 chest compressions (n = 1,253).

Results:

Overall survival was 11% at 1 year, 10.6% at 3 years, and 9.4% at 5 years. Randomization to chest compression only was independently associated with a 10% lower risk of death during the first 30 days after OHCA, and was not associated with mortality during long-term follow-up.

Conclusions:

Dispatcher instructions to perform only chest compressions for patients with OHCA result in better long-term survival than when bystanders are instructed to perform conventional CPR.

Perspective:

Maintaining a cardiac output that is as high as possible by chest compressions is more important than attempting to prevent hypoxemia during the early stage of CPR. When chest compressions are interrupted to deliver rescue breaths, cerebral and coronary perfusion is lower than when chest compressions are uninterrupted. This study demonstrates that the deleterious effects of rescue breaths have a significant impact on 30-day survival after OHCA, and strengthens the case for uninterrupted chest compressions during bystander CPR.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Implantable Devices, SCD/Ventricular Arrhythmias

Keywords: Survivors, Heart Massage, Follow-Up Studies, Out-of-Hospital Cardiac Arrest, Death, Cardiopulmonary Resuscitation, Cardiac Output, Heart Arrest, Pressure


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