CPR Without Mouth-to-Mouth Found Effective in Cardiac Arrest

[roster]

Good news for me!




STOCKHOLM, Dec. 10 -- When bystanders try to help a person in cardiac arrest, a simpler version of CPR using chest compression only appears to work as well as full-scale resuscitation, two studies showed.

In one retrospective and one prospective study published in the Dec. 18/25 issue of Circulation, chest compression without mouth-to-mouth breathing led to survival rates similar to standard CPR.

The findings may save lives, researchers involved in both studies said, because many people hesitate to perform mouth-to-mouth resuscitation for fear of infection.

While waiting for ambulance crews, bystanders used standard CPR in 73% of the cases and chest compression only in 10% of the cases, said Katarina Bohm, R.N., of the Karolinska Institute, who was lead author of a 15-year retrospective study of 11,275 out-of-hospital cardiac arrests in Sweden.

Bohm and colleagues found that there was no significant difference in one-month survival between the two techniques: 7.2% of those who got standard CPR were alive a month later and so were 6.7% of those who got chest compression only.

In 17% of cases, bystanders used mouth-to-mouth alone, without chest compression, but that resulted in a 4.5% survival rate, which was significantly worse (P<0.0001) than standard CPR.

A prospective cohort study in Osaka had slightly different endpoints but came up with similar conclusions, according to Taku Iwami, M.D., Ph.D., of Kyoto University Health Service, and colleagues.

The researchers analyzed 4,902 cardiac arrests that were witnessed by bystanders. In 783 cases, bystanders initiated standard CPR and in 544 cases they performed chest compression only.

The primary endpoint of the study was one-year survival with a favorable neurological outcome and both forms of rescue had similar effectiveness -- 4.1% for standard CPR and 4.3% for chest compression only -- as long as the duration of CPR was less than 15 minutes.

And when emergency crews arrived in less than five minutes, chest compression only appeared to be even slightly superior to standard CPR, the researchers found.

In those cases, the neurologically favorable one-year survival rate for standard CPR was 7.7%, compared with 9.6% for chest compression only.

In the 855 cases where ambulance crews took 15 minutes or more to arrive, the neurologically favorable one-year survival rate was 2.2% for conventional CPR and 0.3% for compression only, Dr. Iwami and colleagues found, but only five patients survived.

Conventional CPR is "a complex psychomotor task and it typically is provided for less than 25% of out-of-hospital [cardiac] arrests, Dr. Iwami and colleagues said.

The simpler chest compression CPR (CC-CPR) "is a much simpler technique that is easier to teach, learn, remember, and perform," the researchers added, noting that in most cases in the study, bystanders did nothing.

And it may be superior to conventional CPR when the time involved is less than five minutes, the researchers said, while adding mouth-to-mouth may be more beneficial when the interval is longer than 15 minutes.

The findings may save lives, researchers involved in both studies said, because many people hesitate to perform mouth-to-mouth resuscitation for fear of infection.

The Swedish study was supported by the Swedish Heart and Lung Foundation and Stockholm County Council. The researchers reported no potential conflicts.

The Japanese study was supported by the Ministry of Education, Science, Sports, and Culture and the Ministry of Health, Labor, and Welfare. The researchers reported no potential conflicts.

Primary source: Circulation
Source reference:
Iwami T, et al "Effectiveness of bystander-initiated cardiac-only resuscitation for patients with out-of-hospital cardiac arrest" Circulation 2007; DOI: 10.1161/CIRCULATIONAHA.107.723411.

Additional source: Circulation
Source reference:
Bohm K, et al "Survival is similar after standard treatment and chest compression only in out-of-hospital bystander cardiopulmonary resuscitation" Circulation 2007; DOI: 10.1161/CIRCULATIONAHA.107.710194.

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[drummergirl410]

I got certified in CPR through the American Heart Association back in August, and what the instructor told us goes right along with this. She said that if for any reason you were uncomfortable with giving mouth to mouth just go with the compressions.

[6PtStar]

Rooster, are you trying to tell us something or am I reading to much into your post.

I had one MD a few years ago tell me that the initial cardiac thump did almost as much good as the continued compressions. Of course he did not have any data or study to back up his statment.

Jerry

[Goofproof]

Sure it works almost as well on normal people, but when they put a bag over my head and try, I don't seem to get as much O2.

Maybe I should start carrying brown paper ones, instead of plastic. Jim

Bag him, Danno! *5"O", book him Danno.

[Country4ever]

Rooster........no wonder you might have alot of leaks!!

That's good news about the CPR. Its always a conflicted thing to give mouth to mouth to a stranger.
About the thump........I think that's most useful in certain arrhythmias, rather than asystole......but I've been out of the nursing loop for a long time, so I'm not sure.
When I used to work in the ER, a few hundred years ago, we had this big table called "Max". It had an arm on it that would do the chest compressions for us automatically. Nobody really cared for it since its just better to be feeling the compressions yourself.
I wonder if leaving the breathing out works just as good, since there's so little O2 in our expired breath? I would imagine that compressing the chest causes a passive inflow of air.
Remember when they used to sort of do CPR (to drowning victims), by working their arms back and forth? That probably passively brought in some air too (but probably didn't do much for a stopped heart).
I've done more CPR than I care to remember.