Duration of Ventilations During Cardiopulmonary Resuscitation by Lay-Rescuers and First Responders: Relationship Between Delivering Chest Compressions and Outcomes

Study Questions:

Do interruptions in chest compressions for ventilation affect outcomes in patients undergoing cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA)?

Methods:

Data on CPR in 199 patients (mean age 66 years) with OHCA were collected in a prospective database in the Netherlands, and correlated with neurologically intact survival to hospital discharge. Chest compression data were recorded by automatic external defibrillators.

Results:

The chest compression rate was slower than the recommended minimum rate of 100 bpm in 19% of patients and faster than the recommended maximum rate of 120 bpm in 23% of patients. The median chest compression fraction was 65%. The median interruption time for two ventilations was 7 seconds, with no significant difference between dispatched first-responders and lay bystanders. Survival to hospital discharge was 25%. The duration of ventilation-related pauses during chest compressions was not an independent predictor of survival.

Conclusions:

The authors concluded that interruptions in chest compression for ventilation have a neutral effect on survival in patients undergoing CPR for OHCA.

Perspective:

The excellent performance of lay rescuers in this study reflects the quality of CPR training of the public in the Netherlands. Although ventilation-related pauses in chest compression did not correlate with survival in this study, it is noteworthy that the pauses were relatively brief, with only 17% of rescuers taking >10 seconds to deliver two ventilations. It is likely that ventilation-related pauses for lay bystanders in the United States are significantly longer. This has provided one of the arguments in favor of compression-only CPR by bystanders.

Clinical Topics: Arrhythmias and Clinical EP, SCD/Ventricular Arrhythmias

Keywords: Out-of-Hospital Cardiac Arrest, Ventilation, Cardiopulmonary Resuscitation, Netherlands


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