Out-of-hospital cardiac arrest claims hundreds of thousands of lives each year worldwide. Successful resuscitation is challenging but achievable, requiring an interdependent set of actions that consist of early arrest recognition, early cardiopulmonary resuscitation (CPR), early defibrillation, expert advanced life support, and timely postresuscitation care.
In a multicenter, randomized trial, Rea et al. compared survival rates between out-of-hospital cardiac arrest patients receiving chest compressions alone versus chest compressions with rescue breathing.
• What is the potential advantage of chest compression alone for CPR?
Chest compression alone may be more acceptable to some laypersons and has the potential physiological advantage of fewer compression interruptions, so that circulation is increased, as compared with traditional CPR, although at a possible cost to oxygenation.
• Was there any survival advantage between chest compressions alone and chest compressions with rescue breathing?
No. In this multicenter, randomized trial, CPR instructions consisting of chest compression alone did not increase the rate of survival to hospital discharge overall, as compared with instructions consisting of chest compression plus rescue breathing.
Morning Report Questions
Q: What was the overall rate of survival to hospital discharge among patients with cardiac arrest?
A: The authors observed no significant difference in the rate of survival to hospital discharge (12.5% for instructions to perform chest compression alone and 11.0% for instructions to perform chest compression plus rescue breathing, P=0.31) or the rate of survival to discharge with a favorable neurologic status (14.4% for chest compression alone and 11.5% for chest compression plus rescue breathing, P=0.13).
Q: Which group of patients appeared to have a better outcome when treated with chest compressions alone as compared to chest compressions with rescue breathing?
A: According to subgroup analysis, among patients whose arrest had a cardiac cause, there was a trend toward an increased rate of survival to hospital discharge (15.5%, vs. 12.3% for patients with other causes of arrest; P=0.09) and an increased rate of survival with a favorable neurologic status at discharge (18.9% vs. 13.5%, P=0.03) with chest compression alone.