Evidence proving compressions-only CPR is superior to the traditional CPR with rescue breathing is lacking. The studies that exist are inconclusive. Now a study in Circulation meta-analyses two of the older studies, and says there actually might be improved survival with compressions-only CPR.

Early bystander CPR is the foundation of the cardiac arrest chain of survival. According to some studies early CPR doubles the chances of survival.

Since a couple of years there has been a shift in bystander CPR.  Nowadays, dispatchers in most systems will advice bystanders to perform CPR with chest compressions only, without rescue breaths. This is a shift from the traditional CPR of compressions with rescue breathing.

It makes sense. It minimises hands-off time, is easier to teach and should significantly lower bystanders threshold for initiating CPR. That is important. I have only had to give rescue breaths once in my career, and just thinking about it makes me want to go down to the corner shop to buy chewing gums. Never again.

Still, so far the evidence for compressions-only CPR over traditional CPR has been lacking. The few randomised trials that exist were inconclusive. The only evidence I know of was a meta-analysis of those few trials suggesting a short term benefit for compressions-only CPR.

The study
This study in circulation is likely the first evidence of a long term benefit of compressions only bystander CPR.

This was a retrospective cohort study of two earlier studies called DART (Dispatched Assisted Resuscitation Trial) and a swedish trial named TANGO. Two studies that looked a survival to discharge differed between OHCA victims who had either chest compressions alone or traditional CPR with rescue breaths. None of them could prove any benefit in the patients randomised to compressions only CPR.

The authors of the study in Circulation extracted 2496 patients from the DART and TANGO-studies. Half of them had traditional CPR and the other half had compressions-only CPR.

Overall survival for both groups was 11% at one year, 10,6% at three years and 9,4% at five years. Long time survival in the compressions-only group seemed to be 1-2 percent better.

Take-home message
The study tells us OHCA-victims stand a 1-2% improved chance of long time survival if the bystander performs compressions-only CPR instead of traditional CPR with rescue breaths.

We´ll see about that. Still, it seems clear to me that compressions-only CPR is at least as good as traditional CPR.

Study lives here:
Circulation. 2012 Dec 10.
Chest Compression Alone CPR is Associated with Better Long-Term Survival Compared to Standard CPR.
Dumas F, Rea TD, Fahrenbuch C, Rosenqvist M, Faxén J, Svensson L, Eisenberg MS, Bohm K.

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  1. Dr Pullen says:

    I also found this Circulation article worth posting about. The hope I think is that without the fear/anxiety factor of mouth-to-mouth rescue breathing maybe a higher bystander participation rate combined with at least as good results may lead to higher bystander rates of hands-only CPR than traditional CPR and therefore save a few more lives. Nice to have better evidence that hands-only CPR is not inferior.

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