CPR with chest compression alone or with rescue breathing?

January 01, 0001

CPR with chest compression alone or with rescue breathing?

These US investigators hypothesized that the dispatcher instructions to bystanders to provide chest compression alone would result in improved survival as compared with instructions to provide chest compression plus rescue breathing. They conducted a multicenter, randomized trial of dispatcher instructions to bystanders for performing CPR. The patients were persons 18 years of age or older with out-of-hospital cardiac arrest. Patients were randomly assigned to receive chest compression alone or chest compression plus rescue breathing.

They found: "Of the 1941 patients who met the inclusion criteria, 981 were randomly assigned to receive chest compression alone and 960 to receive chest compression plus rescue breathing. We observed no significant difference between the two groups in the proportion of patients who survived to hospital discharge (12.5% with chest compression alone and 11.0% with chest compression plus rescue breathing) or in the proportion who survived with a favorable neurologic outcome in the two sites that assessed this secondary outcome (14.4% and 11.5%, respectively). Prespecified subgroup analyses showed a trend toward a higher proportion of patients surviving to hospital discharge with chest compression alone as compared with chest compression plus rescue breathing for patients with a cardiac cause of arrest (15.5% vs. 12.3%, P=0.09) and for those with shockable rhythms (31.9% vs. 25.7%, P=0.09)."

The authors concluded: "Dispatcher instruction consisting of chest compression alone did not increase the survival rate overall, although there was a trend toward better outcomes in key clinical subgroups. The results support a strategy for CPR performed by laypersons that emphasizes chest compression and minimizes the role of rescue breathing."

Standard CPR is no better than chest compressions alone for patients with out-of-hospital cardiac arrest.

For the full abstract, click here.

N Engl J Med 363:423-433, 29 July 2010 © 2010 to the Massachusetts Medical Society
CPR with Chest Compression Alone or with Rescue Breathing. Thomas D. Rea, Carol Fahrenbruch, Linda Culley, et al. Correspondence to Dr. Rea: Thomas D. Rea, Carol Fahrenbruch, Linda Culley, et al

Category: K. Circulatory. Keywords: cardiopulmonary resuscitation, CPR, cardiac arrest, out-of- hospital, emergency services, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 13 August 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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