Bystander Cardiopulmonary Resuscitation: Chest Compression Alone or with Rescue Breathing?

A previous nonrandomized study showed improved outcomes from adult cardiac arrest with compression-only cardiopulmonary resuscitation (CPR) compared with conventional CPR (JW Emerg Med Mar 30 2007). Now, researchers compared outcomes with the two methods in a randomized study of consecutive 911 calls for cardiac arrest to three emergency medical services systems (2 in Washington State and 1 in London). After determining patient eligibility (unconscious, not breathing normally, bystander CPR not already under way), dispatchers randomly assigned patients to chest compression only or conventional CPR and provided instructions to bystanders about how to perform the assigned method. Patients who were younger than 18 years or who had arrest because of trauma, drowning, or asphyxiation were excluded. During the study period, which ranged from 3 to 5 years at the three sites, 1941 patients were enrolled.

No significant differences were noted between the chest-compression–only and conventional CPR groups in rates of survival to hospital discharge — the primary outcome — (12.5% and 11.0%) or favorable neurological status at discharge (14.4% and 11.5%). Prespecified subgroup analysis of patients with cardiac causes of arrest showed no significant difference in overall survival rate between the chest-compression–only and conventional CPR groups (15.5% and 12.3%) but a significant improvement in the rate of neurologically favorable survival in the chest-compression–only CPR group (18.9% vs. 13.5%).