Dissemination of Chest Compression–Only Cardiopulmonary Resuscitation and Survival After Out-of-Hospital Cardiac Arrest

Abstract

Background-The best cardiopulmonary resuscitation (CPR) technique for survival after out-of-hospital cardiac arrests (OHCAs) has been intensively discussed in the recent few years. However, most analyses focused on comparison at the individual level. How well the dissemination of bystander-initiated chest compression-only CPR (CCCPR) increases survival after OHCAs at the population level remains unclear. We therefore evaluated the impact of nationwide dissemination of bystander-initiated CCCPR on survival after OHCA. Methods and Results-A nationwide, prospective, population-based, observational study covering the whole population of Japan and involving consecutive OHCA patients with resuscitation attempts was conducted from January 2005 through December 2012. The main outcome measure was 1-month survival with favorable neurological outcome. The incidence of survival with favorable neurological outcome attributed to types of bystander CPR (CCCPR and conventional CPR with rescue breathing) was estimated. Among 816 385 people experiencing OHCAs before emergency medical services arrival, 249 970 (30.6%) received CCCPR, 100 469 (12.3%) received conventional CPR, and 465 946 (57.1%) received no CPR. The proportion of OHCA patients receiving CCCPR or any CPR (either CCCPR or conventional CPR) by bystanders increased from 17.4% to 39.3% (P for trend <0.001) and from 34.6% to 47.3% (P for trend <0.001), respectively. The incidence of survival with favorable neurological outcome attributed to CCCPR per 10 million population significantly increased from 0.6 to 28.3 (P for trend=0.010), and that by any bystander-initiated CPR significantly increased from 9.0 to 43.6 (P for trend=0.003). Conclusion-Nationwide dissemination of CCCPR for lay-rescuers was associated with the increase in the incidence of survival with favorable neurological outcome after OHCAs in Japan. (Circulation. 2015;132:415-422.

Characteristics of patients who are not resuscitated in out of hospital cardiac arrests and opportunities to improve community response to cardiac arrest

“…Compared to conventional CPR (which includes mouth-to-mouth ventilation), compression only CPR may further reduce reluctance to initiate resuscitation. [18] Training communities to perform CPR can increase bystander CPR rates and overall survival. [6] Training ambulance dispatch staff to provide compression-only CPR telephone instructions both reduces time to first compression and increases chances of bystander CPR initiation.…”

Improved Survival With Favorable Neurological Outcome in Elderly Individuals With Out-of-Hospital Cardiac Arrest in Japan – A Nationwide Observational Cohort Study –

“…These improvements are attributable to improvement in "chain of survival", as well as the revisions of CPR guidelines, education of laypersons in bystander CPR, and the development of a public-access defibrillation strategy. [5][6][7][8][9][10][11][12][13] In this context, it is intriguing that the annual rate of 1-month survival with favorable neurological outcome did not improve in the oldest age group (≥95 years) and patients with unwitnessed OHCA. The oldest age group (≥95 years) had poor prognosis despite their arrests being more frequently witnessed, especially by non-family members, more frequently receiving bystander CPR, and being of a cardiac etiology than the other arrest, large sample size, and population-based study design covering all known OHCAs in Japan, were intended to minimize these potential sources of bias.…”

Sudden cardiac death in the young

“…167 A recent, population-based study from Japan suggests that broad dissemination of chest-compression only CPR for bystanders was associated with a substantial increase in neurologically favorable survival. 221 CPR techniques for young children-The basic physiological principles of CPR apply to babies and children, but there are differences in technique to accommodate age related differences in body size, elasticity of chest wall and differing primary causes of arrest. Thus, the AHA guidelines recommend different compression-ventilation ratios and less compression depth for infants .…”