Bystander Hands-Only CPR Linked to Improved Survival

Megan Brooks

April 02, 2019

Rates of bystander cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) nearly doubled and rates of compression-only CPR jumped sixfold over the past 18 years in Sweden, a new study suggests.

Any type of CPR administered by bystanders was associated with doubled survival rates compared with no CPR before arrival of emergency medical services (EMS), the researchers found.

"These findings support continuous endorsement of compression-only CPR as an option in CPR guidelines," Jacob Hollenberg, MD, PhD, director, Centre for Resuscitation Science, Karolinska Institutet, Stockholm, and scientific chair, Swedish Resuscitation Council, told theheart.org | Medscape Cardiology.

Their results were published online April 1 in Circulation.

The researchers analyzed data on 30,445 bystander-witnessed OHCA reported to the Swedish register for CPR resuscitation for 2000 to 2017.

Overall, 40.0% received no bystander CPR, 39.2% received standard CPR, and 20.8% received CO-CPR. Rates of bystander CPR, and particularly CO-CPR, increased during the three study periods.

CPR Rates by Time Period
CPR Rates 2000–2005, % 2006–2010, % 2011–2017, %
Bystander CPR 40.8 58.8 68.2
Standard CPR 35.4 44.8 38.1
CO-CPR 5.4 14.0 30.1

For all three time periods, 30-day survival was significantly more likely in patients who received standard CPR and CO-CPR than in those who received no CPR.

30-Day Survival With CPR vs No CPR
30-Day Survival 2000–2005, % 2006–2010, % 2011–2017, %
No CPR 3.9 6.0 7.1
Standard CPR 9.4 12.5 16.2
CO-CPR 8.0 11.5 14.3

For all time periods combined, the adjusted odds ratio for 30-day survival was 2.6 (95% CI, 2.4 - 2.9) for standard CPR and 2.0 (95% CI, 1.8 - 2.3) for CO-CPR relative to no CPR. Standard CPR was superior to CO-CPR (adjusted odds ratio, 1.2; 95% CI, 1.1 - 1.4).

"Importantly," said Hollenberg, "randomized, controlled trials are needed to answer the question of whether or not CPR with compression and ventilation is superior to compression-only CPR in cases in which the bystanders have had previous CPR training. In Sweden, a large RCT is currently ongoing trying to answer this question."

"This is an important study," Benjamin Abella, MD, director, Center for Resuscitation Science, University of Pennsylvania Perelman School of Medicine, Philadelphia, told theheart.org | Medscape Cardiology.

"There has been some hesitation to drop ventilation because it's been such a time-honored concept that ventilations are important during CPR," he explained.

"There was a big push in Sweden to improve bystander CPR education using compression-only CPR, which is easier to teach and an easier message for people to hear because people often don't want to put their mouths to a stranger," he said. "This is one the first studies to really clearly show that you can greatly disseminate compression-only CPR as a teaching strategy and you can improve survival not just with regular CPR, but also compression-only CPR."

The study, Abella added, is "one of the strongest pieces of evidence to date supporting the notion that we should be teaching hands-only CPR. In the United States, we still have a long way to go in educating the public and making people fully aware that compression-only CPR is an option."

Lack of awareness that CO-CPR is an option "is an important barrier to people actually performing CPR," said Abella.

The study was funded by the Swedish Heart and Lung Foundation. Hollenberg and Abella have no relevant disclosures.

Circulation. Published online April 1, 2019. Abstract

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