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

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

Chest compression without ventilation is better than standard CPR for adults with primary 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.

Comment: In addition to the fear of contracting disease, the technical aspects of performing conventional CPR might limit bystanders’ resuscitation attempts. In urban systems with dispatcher-directed CPR, the ambulance often arrives on scene before instructions can be explained. The conclusion that chest compression alone is superior to conventional CPR is supported by numerous studies showing that ventilations cause prolonged interruptions in chest compressions and that these interruptions have significant negative consequences. If borne out in larger studies, these findings would have huge outcome and training implications!

— Kristi L. Koenig, MD, FACEP

Published in Journal Watch Emergency Medicine March 30, 2007

Citation(s):

SOS-KANTO study group. Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): An observational study. Lancet 2007 Mar 17; 369:920-6.