Literature Review: Compression-Only CPR by OOHCA Bystanders

   Bobrow BJ, Spaite DW, Berg RA, et al. Chest compression-only CPR by lay rescuers and survival from out-of-hospital cardiac arrest. JAMA 304(13): 1,447-54, Oct 6, 2010.

ABSTRACT

   Chest compression-only bystander cardiopulmonary resuscitation (CPR) may be as effective as conventional CPR with rescue breathing for out-of-hospital cardiac arrest.

   Objective--To investigate the survival of patients with out-of-hospital cardiac arrest using compression-only CPR (COCPR) compared with conventional CPR. Design, setting and patients--A five-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.

   Results--Among 5,272 adults with out-of-hospital cardiac arrest of cardiac etiology not observed by responding emergency medical personnel, 779 were excluded because bystander CPR was provided by a healthcare professional or the arrest occurred in a medical facility. A total of 4,415 met all inclusion criteria for analysis, including 2,900 who received no bystander CPR, 666 who received conventional CPR and 849 who received COCPR. Rates of survival to hospital discharge were 5.2% for the no bystander CPR group, 7.8% for conventional CPR and 13.3% for COCPR. The adjusted odds ratio for survival for conventional CPR vs. no CPR was 0.99, for COCPR vs no CPR was 1.59, and for COCPR vs. conventional CPR was 1.60. From 2005 to 2009, lay rescuer CPR increased from 28.2% to 39.9%; the proportion of CPR that was COCPR increased from 19.6% to 75.9%. Overall survival increased from 3.7% to 9.8%.

   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.

COMMENT

   This study provides us with additional evidence that for layperson CPR, the chest compression-only method appears to be better than chest compressions with rescue breathing. In this group patients who received COCPR were more than 50% more likely to survive than patients who had conventional or no CPR. There are many possible explanations, including the immediate and prolonged reduction of blood flow with any interruption of chest compressions, lower blood flow with positive-pressure ventilations, and the delays that are part of performing a complex task involving both compressions and ventilations.

   This also helps confirm the value of public education efforts in COCPR. One of COCPR's greatest benefits is the associated increase in the public's willingness to learn and use the technique--part of the American Heart Association's Hands-Only CPR campaign. Here, the CPR rate increased from 28% to nearly 40% over five years.

   The role of COCPR for professional rescuers is still unclear. In early treatment, especially for patients in ventricular fibrillation, it appears to be a good alternative. However, for prolonged cardiac arrest; patients with drowning, overdoses or other noncardiac causes; children; and those in PEA or asystole, ventilations continue to have an important role.

   Angelo Salvucci, Jr., MD, FACEP, is medical director for the Santa Barbara County and Ventura County (CA) EMS agencies.