Chest Compression-Only CPR for Out-of-Hospital Cardiac Arrest

Study Questions:

Has the wider dissemination of chest compression-only cardiopulmonary resuscitation (CPR) resulted in an improvement in survival after out-of-hospital cardiac arrest (OHCA)?

Methods:

This prospective, observational study was conducted in Japan, and involved OHCAs that occurred between 2005 and 2012. Starting in 2006, emergency telephone dispatchers encouraged bystanders to provide chest compression-only CPR as compared with conventional CPR, which also includes rescue breathing, especially if it was considered difficult for the lay rescuer to administer rescue breathing. The main outcome was survival at 1 month with a favorable neurological status.

Results:

Among 816,385 OHCAs, 31% received chest compression-only CPR, 12% received conventional CPR, and 57% received no CPR. The proportion of arrest victims receiving any CPR increased from 35% to 47%, and chest compression-only CPR from 17% to 39% during the study period. The incidence of survival (per 10 million individuals) with favorable neurological status attributable to chest compression-only CPR increased from 0.6 to 28 (p = 0.01), and that to any CPR increased from 9 to 44 (p = 0.003).

Conclusions:

Wider dissemination of chest compression-only CPR among lay rescuers was associated with an improved outcome in victims of OHCA.

Perspective:

A concern with chest compression-only CPR is that it may lead to worse outcomes in some arrest victims in whom conventional CPR (with rescue breathing) may be more effective. This study helps assuage these concerns, especially in adult victims with a cardiac etiology of OHCA. This study also complements a prior study by the same investigators that showed the superiority of chest compression-only CPR over conventional CPR in OHCA victims who received shocks from an automated external defibrillator. Although chest compression-only CPR seems very reasonable as the resuscitation method of choice among lay rescuers, conventional CPR may be considered in certain circumstances such as pediatric arrests of noncardiac origin.

Clinical Topics: Arrhythmias and Clinical EP, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Arrhythmias, Cardiac, Cardiopulmonary Resuscitation, Defibrillators, Defibrillators, Implantable, Electric Countershock, Heart Arrest, Out-of-Hospital Cardiac Arrest, Survival


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