Loading...
Findings of several large studies (JW Emerg Med Nov 12 2010; JW Emerg Med Oct 22 2010; JW Emerg Med Jul 28 2010) led to guideline revisions recommending that untrained bystanders perform compression-only cardiopulmonary resuscitation (CPR) for adults with out-of-hospital cardiac arrest. Researchers in Japan analyzed a nationwide emergency medical services database to compare outcomes between patients with bystander-witnessed out-of-hospital cardiac arrest who received conventional CPR (19,328 patients) and those who received chest compression-only CPR (27,707 patients) during a 3-year period.
Rates of both overall 1-month survival and neurologically favorable 1-month survival were significantly higher in patients who received conventional CPR (adjusted odds ratio, 1.17 in each case). In analysis by age and cause of arrest, the benefit of conventional CPR was limited to patients younger than 20 with noncardiac causes. In analysis by time from arrest to start of CPR and cause of arrest, the benefit of conventional CPR over compression-only CPR increased with time to CPR among patients with noncardiac causes and among patients with all causes combined, but not among those with cardiac causes.
Ogawa T et al. Outcomes of chest compression only CPR versus conventional CPR conducted by lay people in patients with out of hospital cardiopulmonary arrest witnessed by bystanders: Nationwide population based observational study. BMJ 2011 Jan 27; 342:c7106. (http://dx.doi.org/10.1136/bmj.c7106)
Comment
This large study confirms that conventional CPR is the preferred technique for children (JW Emerg Med Mar 2 2010), who have a higher proportion of noncardiac causes of arrest than adults. For adults, evidence supports compression-only CPR by bystanders. Outcomes in adults likely would be better with compression-only CPR by trained providers, too, but this is not yet proven; so guidelines continue to recommend conventional CPR by trained healthcare providers.