Lay conventional CPR ‘better than compression-only CPR’
MedWire News: Conventional cardiopulmonary resuscitation (CPR), which involves both rescue breathing and chest compression, is more effective than compression-only CPR for out-of-hospital cardiopulmonary arrest, an observational study has found.
The better outcomes with conventional CPR were more pronounced in selected groups of patients, namely, younger people with arrests of non-cardiac origin and those in whom CPR was delayed by up to 10 minutes.
"These findings could be important for developing new guidelines for bystander CPR," say Toshio Ogawa (Nara Medical University, Japan) and fellow researchers writing in the British Medical Journal.
Ogawa's team sought to clarify controversy over the most effective CPR strategy when administered by lay people. Using a national database they identified all consecutive patients with out-of-hospital cardiopulmonary arrest between January 2005 and December 2007.
All arrests were witnessed at the moment of collapse; lay people attempted chest-compression-only CPR in 20,707 cases and conventional CPR in 19,328 cases.
Ogawa et al found that 1-month survival rates were significantly higher among patients who received conventional CPR as opposed to compression-only CPR, at an adjusted odds ratio (OR) of 1.17.
The same OR, 1.17, was found for the outcome of "neurologically favorable" 1-month survival - ie, alive and with good cerebral performance or moderate cerebral disability.
For both types of CPR, however, the likelihood of a neurologically favorable outcome declined with increasing age and when CPR was delayed by up to 10 minutes after the arrest.
Finally, the benefit of conventional CPR over compression-only CPR was particularly great in people aged under 20 years with arrests of non-cardiac origin (OR=4.65) and in people in whom CPR was delayed by 9-10 minutes (for arrests of non-cardiac origin and all cases combined).
The author of an accompanying editorial speculates that the better outcomes associated with conventional CPR may result from the ventilation and greater oxygenation provided by mouth-to-mouth breathing, which helps to correct global hypoxia.
Editorialist Ian Jacobs (University of Western Australia) writes: "Strategies to increase bystander resuscitation should be encouraged, but not to the abandonment of conventional CPR. Compression only CPR should be viewed as the first resuscitation step, which should be followed as soon as possible by rescue breathing and other basic life support interventions."
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By Joanna Lyford