Chest Compression Alone Is Best for Witnessed Out-of-Hospital Cardiac Arrest

Standard basic cardiopulmonary resuscitation consists of both chest compression and mouth-to-mouth or mask ventilation, but bystanders might be unwilling to perform ventilations, particularly on a stranger. In a prospective, multicenter, observational study, researchers compared 30-day neurologic outcomes among 4068 adults who had out-of-hospital cardiac arrest witnessed by bystanders: 18% received conventional CPR, 11% received chest compressions only, and 72% did not receive CPR.

Although any resuscitation portended a more-favorable 30-day outcome than no resuscitation (5% vs. 2%), chest compression alone was associated with better outcomes than conventional CPR in patients with apnea (6% vs. 3%), in those with shockable rhythms (19% vs. 11%), and in those who received resuscitation within 4 minutes of the arrest (10% vs. 5%). The odds ratio for a favorable outcome after chest compression alone was 2.2 compared with conventional CPR. No subgroup showed any benefit from the addition of mouth-to-mouth ventilation.

An editorialist calls for “prompt interim revision of the guidelines for out-of-hospital cardiac arrest” and notes the paradox of the term “rescue breathing” because it may actually decrease the likelihood of a “rescue” in adults with primary cardiac arrest. Mouth-to-mouth ventilation may be unnecessary with early chest compressions because many patients with primary cardiac arrest continue to gasp and thereby provide physiologic ventilation.