CPR Without Ventilations?

A new study, recently published in JAMA, has reported that cardiopulmonary resuscitation using compressions alone (no ventilations) in out-of-hospital cardiac arrest may be better than standard CPR. The findings have fueled much controversy on the eve of the issuance of the next major revisions of BLS, ACLS and PALS, scheduled for release in Circulation magazine in mid-September of this year. If the findings are borne out in subsequent study and adopted, at least for bystander-assisted resuscitation, it may encourage higher rates of assistance and possibly successful resuscitations. Fewer than 50% of the bystander witnessed cardiac arrests in Seattle receive bystander CPR.

This study was conducted in Seattle’s urban, fire department EMS-based system utilizing dispatchers who gave telephone instruction in compression-alone or conventional CPR in a randomly assigned order of calls for assistance with apparent cardiac arrest. A total of 279 patients received conventional CPR and 241 received chest compressions alone.

There was no statistically significant difference in survival-to-discharge between the two groups (though it was slightly higher in the chest compressions only group, 14.6% to 10.4%). The investigators concluded that the simpler chest compression alone technique may be preferred by inexperienced bystanders.

(N Engl J Med 2000;342:1546-53.)

The Abstract

Background. Despite extensive training of citizens of Seattle in cardiopulmonary resuscitation (CPR), bystanders do not perform CPR in almost half of witnessed cardiac arrests. Instructions in chest compression plus mouth-to-mouth ventilation given by dispatchers over the telephone can require 2.4 minutes. In experimental studies, chest compression alone is associated with survival rates similar to those with chest compression plus mouth-to-mouth ventilation. We conducted a randomized study to compare CPR by chest compression alone with CPR by chest compression plus mouth-to-mouth ventilation.

Methods. The setting of the trial was an urban, fire-department-based, emergency-medical-care system with central dispatching. In a randomized manner, telephone dispatchers gave bystanders at the scene of apparent cardiac arrest instructions in either chest compression alone or chest compression plus mouth-to-mouth ventilation. The primary end point was survival to hospital discharge.

Results. Data were analyzed for 241 patients randomly assigned to receive chest compression alone and 279 assigned to chest compression plus mouth-to-mouth ventilation. Complete instructions were delivered in 62 percent of episodes for the group receiving chest compression plus mouth-to-mouth ventilation and 81 percent of episodes for the group receiving chest compression alone (P=0.005). Instructions for compression required 1.4 minutes less to complete than instructions for compression plus mouth-to-mouth ventilation. Survival to hospital discharge was better among patients assigned to chest compression alone than among those assigned to chest compression plus mouth-to-mouth ventilation (14.6 percent vs. 10.4 percent), but the difference was not statistically significant (P=0.18).

Conclusions. The outcome after CPR with chest compression alone is similar to that after chest compression with mouth-to-mouth ventilation, and chest compression alone may be the preferred approach for bystanders inexperienced in CPR. (N Engl J Med 2000;342:1546-53.)

From the Department of Biostatistics (A.H., E.J.) and the Department of Medicine (L.C., M.C.), University of Washington, and Medic I, Seattle. Address reprint requests to Dr. Hallstrom at 1107 NE 45th St., Suite 505, Seattle, WA 98105-4689.

Return to the ACUTE CARE home page