Compression-Only CPR or Standard CPR in Out-of-Hospital Cardiac Arrest - Compression-Only CPR or Standard CPR in Out-of-Hospital Cardiac Arrest

Jul 28, 2010
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Author/Summarized by Author:
Anthony A. Bavry, MD,MPH,FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Trial Sponsor:
Swedish Heart–Lung Foundation, Stockholm County Council, and SOS Alarm.
Date Published:
01/01/2010
Date Updated:
07/28/2010
Original Posted Date:
07/28/2010
References

Description:

The goal of the trial was to evaluate compression-only cardiopulmonary resuscitation (CPR) or standard CPR among patients with out-of-hospital cardiac arrest.

Hypothesis:

Compression-only CPR would be similar or more effective at improving short-term survival.

Study Design

  • Randomized
  • Parallel

Patient Populations:

  • Witnessed collapse of a patient who remained unconscious without spontaneous breathing

Number of screened applicants: 3,809
Number of enrollees: 1,276
Duration of follow-up: 30 days
Age range: Mean 68 years
Percentage female: 34%

Exclusions:

  • Cardiac arrest by trauma
  • Airway obstruction, drowning, or intoxication
  • Age <8 years
  • Difficulty of dispatcher communicating with the caller

Primary Endpoints:

  • 30-day survival

Secondary Endpoints:

  • One-day survival
  • Survival until hospital discharge

Drug/Procedures Used:

Patients with witnessed out-of-hospital cardiac arrest were randomized to compression-only CPR (n = 620) versus standard CPR with chest compressions and ventilation (n = 656).

The instructions for CPR were given by a medical dispatcher prior to arrival of emergency medical services (EMS) personnel.

Principal Findings:

Overall 1,276 patients were randomized. In the compression-only CPR group, the mean age was 68 years, 34% were women, and the location of the cardiac arrest was the home in 76%. The first cardiac rhythm was ventricular fibrillation/tachycardia in 34%, asystole in 58%, and pulseless electrical activity in 8%.

The 30-day survival rate was 8.7% (54 of 620 patients) in the compression-only group versus 7.0% (46 of 656 patients) in the standard CPR group (p = 0.29). Results were similar when analyzed per-protocol and according to age (p for interaction = 0.50), gender (p for interaction = 0.22), time between call and EMS response (p for interaction = 0.95), and first cardiac rhythm (p for interaction = 0.99). One-day survival was 24.0% versus 20.9% (p = 0.18) and survival to discharge from the hospital was 19.1% versus 14.8% (p = 0.16), respectively.

Interpretation:

Among patients who suffered a witnessed out-of-hospital cardiac arrest, compression-only CPR resulted in similar 30-day survival as standard CPR. Although there was no significant difference in the primary outcome between the two groups, the compression-only group had a nonsignificant increase in 30-day survival. Findings were similar in various sub-groups.

This study highlights the overall dismal prognosis of out-of-hospital cardiac arrest. Since compression-only CPR is easier to perform by laypeople and it results in similar outcomes as standard CPR, it will likely remain an option, or become preferred in future CPR guidelines.

References:

Svensson L, Bohm K, Castren M, et al. Compression-only CPR or standard CPR in out-of-hospital cardiac arrest. N Engl J Med 2010;363:434-442.

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

Keywords: Prognosis, Out-of-Hospital Cardiac Arrest, Emergency Medical Services, Survival Rate, Cardiopulmonary Resuscitation, Ventricular Fibrillation, Heart Arrest, Tachycardia


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