Survival After CPR With Chest Compressions Only

Study Questions:

How has the rate of chest compression–only cardiopulmonary resuscitation (CO-CPR) versus standard CPR (S-CPR) changed over time, and how did this change impact 30-day survival among out-of-hospital cardiac arrest victims?


All bystander-witnessed out-of-hospital cardiac arrests reported to the Swedish register for CPR from 2000 to 2017 were analyzed. Patients were categorized as receivers of no CPR (NO-CPR), S-CPR, or CO-CPR before emergency medical service (EMS) arrival. Guideline periods 2000–2005, 2006–2010, and 2011–2017 were used for comparisons over time. The primary outcome was 30-day survival.


There was a total of 30,445 patients. The proportions of patients receiving CPR before EMS arrival changed from 41% in the first time period to 59% in the second period, and to 68% in the last period. S-CPR changed from 35.4% to 44.8% to 38.1%, and CO-CPR changed from 5% to 14% to 30%, respectively. Thirty-day survival changed from 4% to 6% to 7% in the NO-CPR group, from 9% to 13% to 16% in the S-CPR group, and from 8% to 12% to 14% in the CO-CPR group. For all time periods combined, the adjusted odds ratio for 30-day survival was 2.6 (95% confidence interval [CI], 2.4–2.9) for S-CPR and 2.0 (95% CI, 1.8–2.3) for CO-CPR, in comparison with NO-CPR. S-CPR was superior to CO-CPR (odds ratio, 1.2; 95% CI, 1.1–1.4).


During the study period, there was an almost two-fold higher rate of CPR before EMS arrival and a six-fold higher rate of CO-CPR over time. Any type of CPR was associated with doubled survival rates in comparison with NO-CPR.


The most important intervention in witnessed cardiac arrest is the implementation of CPR. Some of the most common barriers to the initiation of bystander CPR are lack of knowledge about how to perform CPR, worry about causing harm, and the possibility of an infection with mouth-to-mouth ventilations. Since 2010, CPR guidelines have recommended CO-CPR for both untrained bystanders and trained bystanders unwilling to perform rescue breaths. CO-CPR is easier to teach and perform, especially in the setting of dispatch-assisted resuscitation. The findings of this study support continued endorsement of CO-CPR as an option in CPR guidelines because CO-CPR is associated with higher CPR rates and overall survival in out-of-hospital cardiac arrest.

Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure

Keywords: Acute Coronary Syndrome, Arrhythmias, Cardiac, Cardiopulmonary Resuscitation, Emergency Medical Services, Heart Arrest, Heart Failure, Out-of-Hospital Cardiac Arrest, Primary Prevention, Survival Rate, Sweden

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