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Compression-Only CPR Is Less Effective Than Conventional CPR in Some Patients

Among patients with out-of-hospital cardiac arrest in Japan, compression-only cardiopulmonary resuscitation was less effective than conventional CPR in patients younger than 20 with noncardiac causes of arrest.

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.

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.

— Kristi L. Koenig, MD, FACEP

Published in Journal Watch Emergency Medicine March 4, 2011

Citation(s):

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)

Reader Remarks:

Review and add to remarks on this article

• Common sense
  S M, 7 Mar 2011 12:49 PM EST
  Specialty: Internal Medicine
  It validates thoughts of many medical professional. If you can do a conventional CPR. Do that preferably . I guess... [more]
• CPR Compression Only
  Anthony J Ferrer, 7 Mar 2011 12:49 PM EST
  Specialty: Emergency Medicine
  As an EMT-P, CPR Compression Only contract-indicates the ABC rescue procedures EMT and Medics train for. It is extremely difficult... [more]
• Compression-Only CPR Is Less Effective Than Conventional CPR in Some Patients
  f fallahian, 9 Mar 2011 12:49 PM EST
  Specialty: Critical Care Med (Int Med)
  It is important even before or at time of chest compression to be sure of patency of airway (position of... [more]
• untrained bystanders
  Ed Chung, 9 Mar 2011 12:49 PM EST
  Specialty: Pediatrics
  Remember that compression-only CPR applies only to untrained bystanders. As an EMT-P, you're certainly not an untrained bystander. The hope... [more]
• Compression-Only CPR Is Less Effective Than Conventional CPR in Some Patients
  f fallahian, 10 Mar 2011 9:14 AM EST
  Specialty: Critical Care Med (Int Med)
  Dear colleague, although it seems that arbitrary rule of 8-10 breath per minute in new CPR guideline is a matter... [more]
• Hands-Only is best for medics, nurses and doctors
  Tim Noonan, EMS, 3 Jan 2012 3:01 PM EST
  Specialty: Other Specialty
  Why do we assume that medical professionals cannot identify children and cannot identify respiratory causes of arrest? Are we really... [more]

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