Cardiopulmonary Resuscitation by Chest Compression Alone or with Mouth-to-Mouth Ventilation

Hallstrom, Alfred P.; Cobb, Leonard A.; Johnson, E. S.; Copass, Michael K.

doi:10.1056/nejm200005253422101

Cited by 497 publications

(245 citation statements)

References 11 publications

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“…Another basis of the recommendation is that conventional CPR may be associated with delayed initiation of BCPR and consequently diminished effect of BCPR, particularly when dispatchers provided DA-CPR instruction on bystanders [1,9]. This study showed that the incidence of ventilation-only BCPR decreased after implementation of the new JRC guidelines 2005 released at the end of 2006.…”

Section: Discussionmentioning

confidence: 74%

“…The latter meta-analysis included prospective randomized studies that compared dispatcher-assisted compression-only CPR with conventional CPR; these randomized studies revealed the superiority of compressiononly CPR to conventional CPR [1,3]. The former meta-analyses included observational studies investigating the difference in outcomes between compression-only CPR and conventional CPR, in all OHCA having bystander CPR [13].…”

Section: Discussionmentioning

confidence: 99%

“…This rare ventilation-only bystander CPR (BCPR) has been believed to be ineffective, and simply grouped as no BCPR or excluded from analysis [1][2][3][4]. Consequently, neither the effects of ventilation-only BCPR on bystander-witnessed OHCA outcomes nor the factors associated with ventilation-only BCPR have been studied in a population-based cohort.…”

Section: Introductionmentioning

confidence: 99%

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Impact of bystander-performed ventilation on functional outcomes after cardiac arrest and factors associated with ventilation-only cardiopulmonary resuscitation: A large observational study

et al. 2015

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Aim: To determine the effectiveness of ventilations in bystander cardiopulmonary resuscitation (BCPR) and to identify the factors associated with ventilation-only BCPR.Methods: From out-of-hospital cardiac arrest (OHCA) data prospectively collected from 2005 to 2011 in Japan, we extracted data for 210,134 bystander-witnessed OHCAs with complete datasets but no prehospital involvement of physician [no BCPR, 115,733;2,093; 61,075; and conventional (compressions + ventilations) BCPR, 31,233] and determined the factors associated with 1-month neurologically favourable survival using simple and multivariable logistic regression analyses. In 91,885 patients with known BCPR durations, we determined the factors associated with ventilation-only BCPR.Results: The rate of survival in the no BCPR, ventilation-only, compression-only and conventional group was 2.8%, 3.9%, 4.5% and 5.0%, respectively. After adjustment for other factors associated with outcomes, the survival rate in the ventilation-only group was higher than that in the no BCPR group (adjusted OR; 95% CI, 1.29; 1.01-1.63), but lower than that in the compression-only (0.76; 0.59-0.96) or conventional groups (0.70; 0.55-0.89). Conventional CPR had the highest OR for survival in almost all OHCA subgroups. The adjusted OR (95% CI) for survival after dividing BCPR into ventilation and compression components were 1.19 (1.11-1.27) and 1.60 (1.51-1.69), respectively. Older guidelines, female sex, younger patient age, bystander-initiated CPR without instruction, early BCPR and short BCPR duration were associated with ventilation-only BCPR.Conclusions: Ventilation is a significant component of BCPR, but alone is less effective than compression in improving neurologically favourable survival after OHCAs.Word count: 247

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of bystander-performed ventilation on functional outcomes after cardiac arrest and factors associated with ventilation-only cardiopulmonary resuscitation: A large observational study

et al. 2015

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“…Bystanders are reluctant to perform chest compression because of fear of causing harm, fear of litigation, the complexity of performing mouth‐to‐mouth rescue breathing, and the unwillingness to perform mouth‐to‐mouth contact 4, 5, 6. Bystanders’ reluctance may be due to their insufficient knowledge, skills, or confidence.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of dispatcher training in increasing bystander chest compression for out‐of‐hospital cardiac arrest patients in Japan

Tsunoyama

Nakahara

Yoshida

et al. 2017

Acute Medicine & Surgery

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AimThe Japanese government has developed a standardized training program for emergency call dispatchers to improve their skills in providing oral guidance on chest compression to bystanders who have witnessed out‐of‐hospital cardiac arrests (OHCAs). This study evaluated the effects of such a training program for emergency call dispatchers in Japan.MethodsThe analysis included all consecutive non‐traumatic OHCA patients transported to hospital by eight emergency medical services, where the program was implemented as a pilot project. We compared the provision of oral guidance and the incidence of chest compression applications by bystanders in the 1‐month period before and after the program. Data collection was undertaken from October 2014 to March 2015.ResultsThe 532 non‐traumatic OHCA cases were used for analysis: these included 249 cases before and 283 after the guidance intervention. Most patients were over 75 years old and were men. After the program, provision of oral guidance to callers slightly increased from 63% of cases to 69% (P = 0.13) and implementation of chest compression on patients by bystanders significantly increased from 40% to 52% (P = 0.01). Appropriate chest compression also increased from 34% to 47% (P = 0.01). In analysis stratified by the provision of oral guidance, increased chest compressions were observed only under oral guidance.ConclusionsWe found increased provision of oral guidance by dispatchers and increased appropriate chest compressions by bystanders after the training program for dispatchers had been rolled out. Long‐term observation and further data analysis, including patient outcomes, are needed.

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“…In our animal models of VF arrest, we initially found that survival was similar with CO‐CPR and guideline protocols that recommended ventilations 21, 22. Support in humans for CO‐CPR at that time was a study by Hallstrom and associates of dispatcher‐assisted CPR that found CO‐CPR was as effective as standard CPR 23. Further support came later by the important SOS‐KANTO study from Japan 14…”

Section: Resuscitation Research Led To New Approachesmentioning

confidence: 78%

Cardiocerebral and cardiopulmonary resuscitation – 2017 update

Ewy

2017

Acute Medicine & Surgery

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Sudden cardiac arrest is a major public health problem in the industrialized nations of the world. Yet, in spite of recurrent updates of the guidelines for cardiopulmonary resuscitation and emergency cardiac care, many areas have suboptimal survival rates. Cardiocerebral resuscitation, a non‐guidelines approach to therapy of primary cardiac arrest based on our animal research, was instituted in Tucson (AZ, USA) in 2002 and subsequently adopted in other areas of the USA. Survival rates of patients with primary cardiac arrest and a shockable rhythm significantly improved wherever it was adopted. Cardiocerebral resuscitation has three components: the community, the pre‐hospital, and the hospital. The community component emphasizes bystander recognition and chest compression only resuscitation. Its pre‐hospital or emergency medical services component emphasizes: (i) urgent initiation of 200 uninterrupted chest compressions before and after each indicated single defibrillation shock, (ii) delayed endotracheal intubation in favor of passive delivery of oxygen by a non‐rebreather mask, (iii) early adrenaline administration. The hospital component was added later. The national and international guidelines for cardiopulmonary resuscitation and emergency medical services are still not optimal, for several reasons, including the fact that they continue to recommend the same approach for two entirely different etiologies of cardiac arrest: primary cardiac arrest, often caused by ventricular fibrillation, where the arterial blood oxygenation is little changed at the time of the arrest, and secondary cardiac arrest from severe respiratory insufficiency, where the arterial blood is severely desaturated at the time of cardiac arrest. These different etiologies need different approaches to therapy.

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Cardiopulmonary Resuscitation by Chest Compression Alone or with Mouth-to-Mouth Ventilation

Abstract: The outcome after CPR with chest compression alone is similar to that after chest compression with mouth-to-mouth ventilation, and chest compression alone may be the preferred approach for bystanders inexperienced in CPR.

Cited by 497 publications

References 11 publications

Impact of bystander-performed ventilation on functional outcomes after cardiac arrest and factors associated with ventilation-only cardiopulmonary resuscitation: A large observational study

Impact of bystander-performed ventilation on functional outcomes after cardiac arrest and factors associated with ventilation-only cardiopulmonary resuscitation: A large observational study

Effectiveness of dispatcher training in increasing bystander chest compression for out‐of‐hospital cardiac arrest patients in Japan

Cardiocerebral and cardiopulmonary resuscitation – 2017 update

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