Chest-compression-only CPR ‘should be standard’ for bystander resuscitation

By Eleanor McDermid, Senior medwireNews Reporter

Cardiopulmonary resuscitation (CPR) with chest compressions only seems to be the most effective form of resuscitation when delivered by lay bystanders along with public-access automated external defibrillation (AED), research suggests.

"The present study suggests that the combination of early defibrillation with public-access AEDs and [chest-compression-only] CPR by bystanders is the best way to save lives after sudden cardiac arrests," say the researchers, led by Taku Iwami (Kyoto University Health Service, Japan).

In all, 40.7% of patients who had a witnessed out-of-hospital cardiac arrest and received this combination of treatment survived with good neurologic outcomes.

"This is one of the highest survival rates with neurologically favorable outcome reported and should be the target survival after [out-of-hospital cardiac arrest]," say Iwani et al.

The team analyzed data on 1376 patients with a witnessed out-of-hospital cardiac arrest, who received CPR and AED from bystanders. Nearly two-thirds of patients received traditional CPR, with rescue breathing, and 32.9% of these survived with good neurologic outcomes at 1 month (Cerebral Performance Category Scale 1-2).

After accounting for confounders, patients who received chest-compression-only CPR were 33% more likely to achieve these outcomes than those given traditional CPR.

"Rescue breathing is so difficult to perform that it can interrupt chest compressions," suggests the team.

Patients receiving chest compressions only, in addition to AED, were more likely than those given traditional CPR to have prehospital return of spontaneous circulation (50.2 vs 40.5%) and to be alive at 1 month (46.4 vs 39.9%).

Iwani et al note there is mounting evidence for the superior effectiveness of chest-compression-only over conventional CPR for cardiac arrest of cardiac origin. Given this, "difficulties in performing CPR in real settings, and the low proportion of bystander CPR, we think [chest-compression-only] CPR should be the standard for the lay rescuer CPR program," they write in Circulation.

Besides the type of CPR, the chances for neurologically favorable survival were increased with younger age, by 4.76-fold in adults aged 18-74 years and 9.46-fold in children, relative to adults aged 75 years or older. Shorter time between arrest and first shock also improved patients chances for a good outcome, by 7% for each minute reduction.

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