Two studies about chest compression only CPR

hands only CPR American Heart Association had for the first time officially endorsed chest compressions only CPR without rescue breaths in 2008. This recommendation, made a lot of sense, since a lot of people are unwilling to give rescue breaths in the first place. Some fear disease and others feel disgusted by the very idea of “kissing” a stranger. Unfortunately, instead of doing something, these people often do nothing at all, leaving out not only rescue breaths, but chest compressions too. Furthermore, a lot of people cannot remember and are confused about the correct ration of compressions and ventilations. Also, most layman who do perform rescue breaths, do so poorly, and additionally make long pauses in which no compressions are delivered. All of this is certainly not good for a victim of cardiac arrest, and doing something rather than nothing, sure seams more reasonable.

Two studies published this month in well respected medical journals, showed that advocating bystander hands only CPR was indeed a really good decision.

1. The Journal of American Medical Association article
Chest compression-only CPR by lay rescuers and survival from out-of-hospital cardiac arrest
Bobrow BJ, Spaite DW, Berg RA, Stolz U, Sanders AB, Kern KB, Vadeboncoeur TF, Clark LL, Gallagher JV, Stapczynski JS, LoVecchio F, Mullins TJ, Humble WO, Ewy GA. JAMA. 2010;304:1447-54.

Group of authors from Arizona Department of Health Services published a 5 year prospective observational cohort study of survival in patients with out of hospital cardiac arrest. They included 4415 patients, out of whom 2900 received no bystander CPR, 666 received conventional CPR with rescue breaths, and 849 received hands only CPR. In short, patients who received hands only CPR had a better rate of survival to hospital discharge compared to those resuscitated with conventional CPR (13.3% versus 7.8%).

2. The Lancet article
Chest-compression-only versus standard cardiopulmonary resuscitation: a meta-analysis
Michael Hüpfl, Harald F Selig, Dr Peter Nagele. The Lancet, Early Online Publication, 15 October 2010

This meta analysis included three randomized trials and seven observational cohort studies to compare survival to hospital discharge between bystander hands only CPR and standard CPR. Randomized trials showed that hands only CPR was associated with improved chances of survival (14% versus 12%). Observational studies showed no difference regarding CPR techniques.

For hands only CPR to be advised for bystanders, it is sufficient that it results in survival rates that are more or less equal to those achieved with conventional CPR. But for it to be responsible for improved survival rate is a far stronger argument. Although to some these results might come as a surprise, when you look at the scientific evidence produced during the last couple of years, it actual makes sense. Today we know that good quality chest compressions are very important, and that interruptions are harmful. Also, rescue breaths are probably not that important in the first minutes of cardiac arrest, since the blood still contains oxygen, and the main problems is the need to distribute it. That said we still need to be carful of arrests which are primarily of respiratory origin, and arrests in children. Also, professional rescuers should still include rescue breaths/ventilations during CPR. However it seams safe to recommend hands only CPR for bystanders and emergency medical services dispatchers should provide instructions for this technique.

It will be interesting to see what the new CPR guidelines will bring and will they put emphasis on good quality chest compressions and hands only CPR for bystanders. New CPR guidelines will be published tomorrow, and we will be informing you of the changes early in the morning, so be sure to drop by.