Compression-only bystander CPR as effective as traditional CPR
MedWire News: The omission of mouth-to-mouth ventilation from conventional bystander cardiopulmonary resuscitation (CPR) does not affect the outcomes of patients with witnessed cardiac arrest, report two studies.
Lay bystanders often perform mouth-to-mouth ventilation incorrectly or with caution due to safety concerns Therefore, removing the requirement for "rescue breaths" from CPR guidelines may increase the overall efficacy of bystander CPR suggested Myron Weisfeldt (Johns Hopkins University School of Medicine, Baltimore, USA) in a related editorial.
The studies published in the New England Journal of Medicine investigated the outcomes of patients with out-of-hospital cardiac arrest who were randomly assigned to receive continuous compression-only bystander CPR or conventional bystander CPR using alternating chest compressions and mouth-to-mouth ventilation.
In both studies, bystanders performed CPR as instructed by emergency dispatchers via telephone, while awaiting the arrival of emergency medical assistance.
The first study, by Thomas Rea (University of Washington, Seattle, USA) and colleagues, reported no significant difference in survival-to-discharge rates between the patients who received compression-only CPR (n=981), and those who received conventional CPR (n=960), at 12.5% and 11.0%, respectively.
In addition, no significant difference was found in the rates of favorable neurologic outcomes, defined as Cerebral Performance Category of 1 or 2, among both patient groups, at 14.4% and 11.5% for compression-only and conventional groups, respectively.
Subgroup analysis of the cause of cardiac arrest revealed that for cardiac causes, compression-only CPR increased survival-to-discharge rates compared with conventional CPR, at 15.5% and 12.3%, respectively, (p=0.09). However for noncardiac causes of cardiac arrest, rates of survival-to-discharge were higher among patients receiving conventional CPR than compression-only CPR, at 7.2% versus 5.0% (p=0.29).
Rea et al suggest that the findings of the subgroup analysis "may support a more targeted application of type-specific CPR" in which rescue breaths are only implemented in CPR for patients with a known underlying noncardiac condition.
The second study, by Leif Svensson (Stockholm Prehospital Center, Sweden) and colleagues, reported a nonsignificantly higher 30-day survival rate among the compression-only group (n=620) compared with the conventional CPR group (n=650), at 8.7% and 7.0%, respectively.
Svensson et al conclude: "Compression-only CPR, which is easier to learn and to perform, should be considered the preferred method for CPR performed by bystanders in patients with cardiac arrest."
However, Rea et al emphasize that the results of their study "do not apply to health professionals, who have a duty to respond and are more practiced and proficient in CPR, often engaging at a later stage of arrest physiology."
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By Lauretta Ihonor