Tuesday, October 12, 2010

JAMA: Compression Only CPR



# 4975



Earlier this summer we saw the results of a Swedish Study (NEJM CPR with Chest Compression Alone or with Rescue Breathing) that showed that long-term survival rates among adults who received compression-only CPR by untrained bystanders was comparable to those that received CPR with ventilation.


Results Of CPR Without Rescue Breathing


Doing 1-man CPR, even for a trained responder, can be difficult and quickly exhausting.  For a layperson, changing from compressions to rescue breaths and back again to compressions can be awkward and ultimately inefficient.


The end result is often poor ventilation and poor circulation.


Add to that the (understandable) reluctance of many bystanders to perform mouth-to-mouth resuscitation, and you have a recipe for a high rate of failure.


Emergency dispatchers have found that they can coach untrained bystanders to do chest compressions relatively easily, and without the mouth-to-mouth component, more people are willing to assist.


And so the move over the past couple of years has been away from the standard CPR that has been taught for 50 years, and towards compression-only CPR.


Last week, another study appeared in JAMA  – this time emanating from my old paramedic stomping grounds of Arizona – that reaffirms what was reported earlier in the Swedish study.


Below are a few excerpts from the abstract.  Follow the link to read the entire (open access) article.



Chest Compression–Only CPR by Lay Rescuers and Survival From Out-of-Hospital Cardiac Arrest

Bentley J. Bobrow, MD; Daniel W. Spaite, MD; Robert A. Berg, MD; Uwe Stolz, PhD, MPH; Arthur B. Sanders, MD; Karl B. Kern, MD; Tyler F. Vadeboncoeur, MD; Lani L. Clark, BS; John V. Gallagher, MD; J. Stephan Stapczynski, MD; Frank LoVecchio, DO; Terry J. Mullins, MBA; Will O. Humble, MPH; Gordon A. Ewy, MD
JAMA. 2010;304(13):1447-1454. doi:10.1001/jama.2010.1392


Design, Setting, and Patients A 5-year prospective observational cohort study of survival in patients at least 18 years old with out-of-hospital cardiac arrest between January 1, 2005, and December 31, 2009, in Arizona. The relationship between layperson bystander CPR and survival to hospital discharge was evaluated using multivariable logistic regression.


Main Outcome Measure Survival to hospital discharge.




Conclusion Among patients with out-of-hospital cardiac arrest, layperson compression-only CPR was associated with increased survival compared with conventional CPR and no bystander CPR in this setting with public endorsement of chest compression–only CPR.


The details of the study are as follows:


Researchers looked at survival rates of 4,415 patients aged 18 and older who experienced non-hospital cardiac arrest between 2005 and 2009.

Of those, 2,900 received no CPR, 666 received traditional CPR, and 849 received compression-only CPR.


Only 5.2% of those who received no CPR and only 7.8% of those who received conventional CPR survived to discharge.


Whereas 13.3% of those who received chest compression only CPR survived.


The University of Arizona’s Sarver Heart Center has put together a short (6 minute) instructional video which you can view below or on youtube on how to perform this new, easier CPR.



If YouTube is blocked by your organization, you can watch the video on the Arizona Health Sciences Center site.


The American Heart Association has also endorsed this new CPR standard for laypersons, and has a website called http://handsonlycpr.org/





It is important to note that compression-only CPR is recommended for lay-persons untrained in conventional CPR to perform on ADULTS who have collapsed with cardiac arrest.


Conventional CPR is still recommended for infants, small children, and victims of drowning.


The American Heart Association has a brief video demonstrating the technique, also available on Youtube.




While these videos are useful aids, it is still important to take a CPR course, and to recertify every few years.


Hands-only CPR isn’t always appropriate, and the need for conventional CPR skills remain, particularly when dealing with infants and young children.



To find a local CPR course contact your local chapter of the American Red Cross, the American Heart Association, or (usually) your local fire department or EMS can steer you to a class.

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