To ventilate or not to ventilate during bystander CPR — A EuReCa TWO analysis

Abstract

Background: Survival after out-of-hospital cardiac arrest (OHCA) is still low. For every minute without resuscitation the likelihood of survival decreases.One critical step is initiation of immediate, high quality cardiopulmonary resuscitation (CPR). The aim of this subgroup analysis of data collected for the European Registry of Cardiac Arrest Study number 2 (EuReCa TWO) was to investigate the association between OHCA survival and two types of bystander CPR namely: chest compression only CPR (CConly) and CPR with chest compressions and ventilations (FullCPR).Method: In this subgroup analysis of EuReCa TWO, all patients who received bystander CPR were included. Outcomes were return of spontaneous circulation and survival to 30-days or hospital discharge. A multilevel binary logistic regression analysis with survival as the dependent variable was performed.Results: A total of 5884 patients were included in the analysis, varying between countries from 21 to 1444. Survival was 320 (8%) in the CConly group and 174 (13%) in the FullCPR group. After adjustment for age, sex, location, rhythm, cause, time to scene, witnessed collapse and country, patients who received FullCPR had a significantly higher survival rate when compared to those who received CConly (adjusted odds ration 1.46, 95% confidence interval 1.17À1.83). Conclusion:In this analysis, FullCPR was associated with higher survival compared to CConly. Guidelines should continue to emphasise the importance of compressions and ventilations during resuscitation for patients who suffer OHCA and CPR courses should continue to teach both.

Changes in neurological outcomes of out-of-hospital cardiac arrest during the COVID-19 pandemic in Japan: a population-based nationwide observational study

“…In 2020, ILCOR recommended hands-only CPR without respiratory management for patients with OHCA in response to the COVID-19 pandemic. Since hands-only CPR that avoids ventilation has been reported to be associated with worse prognosis, 27 the increased rate of hands-only CPR in this study might have also contributed to worse neurological outcomes. Moreover, the quality of CPR by EMS personnel can drop when personal protective equipment is used.…”

Meta-analysis of chest compression-only versus conventional cardiopulmonary resuscitation by bystanders for adult with out-of-hospital cardiac arrest

“…A total of 1319 records were identified, of which duplicate records and further 783 records were excluded based on the title and abstract evaluation. After review of the remaining 39 articles in full, 15 articles [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] ultimately met the inclusive criteria and were included in the meta-analysis.…”

“…Included trials were published between 2000 and 2021, totaling 220,945 OHCA patients (80,051 in standard CPR group and 140,894 in the CCC group). Overall, 3e studies were randomized controlled trials [20][21][22] with the remaining being non-randomized [23][24][25][26][27][28][29][30][31][32][33][34].…”

European Registry of Cardiac Arrest – Study-THREE (EuReCa THREE) – An international, prospective, multi-centre, three-month survey of epidemiology, treatment and outcome of patients with out-of-hospital cardiac arrest in Europe – The study protocol

“…For EuReCa TWO, the data collection period was increased to three months and 28 countries participated, with many countries also increasing the population covered and improving the overall data quality. 10 , 11 …”