Hands-Only CPR/Defibrillation Best for Out-of-Hospital Cardiac Arrest in Study

December 12, 2012

KYOTO, Japan — Compression-only cardiopulmonary resuscitation (CPR) is associated with better neurological outcomes at one month when compared with conventional CPR for out-of-hospital cardiac-arrest (OHCA) patients, according to a new study [1]. Individuals with bystander-witnessed cardiac arrests undergoing chest-compression CPR and defibrillation with public-access automated external defibrillators (AEDs) were 33% more likely to be alive at one month with favorable neurological outcomes than those who underwent CPR with chest compressions and rescue breathing followed by defibrillation.

"The present study suggests that the combination of early defibrillation with public-access AEDs and chest-compression CPR by bystanders is the best way to save lives after sudden cardiac arrests," write Dr Taku Iwami (Kyoto University Health Service, Japan) and colleagues in a report published online December 10, 2012 in Circulation. "Neurologically favorable survival after witnessed ventricular fibrillation was >40% among those who received chest-compression CPR and defibrillation with public-access AEDs. This is one of the highest survival rates with neurologically favorable outcomes reported and should be the target survival after OHCA."

In Japan, public-access AEDs have been integrated into the system of care, and this allowed the researchers to compare neurological outcomes among 1376 OHCA patients who received either conventional or chest-compression CPR and shocks with public-access AEDs. Of these individuals, 506 were treated with chest-compression-only CPR and 870 received conventional CPR with airway breathing.

At one month, 40.7% of the chest-compression CPR individuals were alive with a favorable neurological outcome compared with 32.9% in conventional CPR arm. This translated into an adjusted odds ratio of 1.33 favoring chest-compression CPR (95% CI 1.03–1.70). The neurological outcome was based on a cerebral performance category score, with a favorable outcome considered one in which the patient had good cerebral performance or moderate cerebral disability.

Just last week, Drs Gordon Ewy and Arthur Sanders (University of Arizona College of Medicine, Tucson) published a report in the Journal of the American College of Cardiology showing that the adoption of chest-compressions-only resuscitation over traditional CPR for bystander intervention in OHCA dramatically improved survival rates in Arizona and other regions of the US. In 2010, the CPR guidelines were changed to recommend chest-compression CPR for untrained rescuers and dispatcher-assisted CPR, part of the American Heart Association Hands-Only CPR campaign, to increase chest compressions by bystanders.

In Circulation, Iwami et al state that rescue breathing can be difficult to perform and interfere with chest compressions. The Japanese CPR guidelines have started to recommend chest-compression CPR training for lay rescuers to increase CPR and AED use, but conventional CPR with rescue breathing is still the standard. Chest-compression-CPR training is typically limited to people who cannot receive the conventional CPR training.