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. 2010;2(4):279-85.

Bystander-initiated chest compression-only CPR is better than standard CPR in out-of-hospital cardiac arrest

L Cabrini  1 , G Biondi-Zoccai, G Landoni, M Greco, F Vinciguerra, T Greco, L Ruggeri, J Sayeg, A Zangrillo
Affiliations

Bystander-initiated chest compression-only CPR is better than standard CPR in out-of-hospital cardiac arrest

L Cabrini et al. HSR Proc Intensive Care Cardiovasc Anesth. 2010.

Abstract

Introduction: Out-of-hospital cardiac arrest has a low survival rate to hospital discharge. Recent studies compared a simplified form of CPR, based on chest compression alone versus standard CPR including ventilation. We performed systematic review and meta-analysis of randomized controlled trials, focusing on survival at hospital discharge.

Methods: We extensively searched the published literature on out-of hospital CPR for non traumatic cardiac arrest in different databases.

Results: We identified only three randomized trials on this topic, including witnessed and not-witnessed cardiac arrests. When pooling them together with a meta-analytic approach, we found that there is already clinical and statistical evidence to support the superiority of the compression-only CPR in terms of survival at hospital discharge, as 211/1842 (11.5%) patients in the chest compression alone group versus 178/1895 (9.4%) in the standard CPR group were alive at hospital discharge: odds ratio from both Peto and DerSimonian-Laird methods =0.80 (95% confidence interval 0.65-0.99), p for effect =0.04, p for heterogeneity =0.69, inconsistency =0%).

Conclusions: Available evidence strongly support the superiority of bystander compression-only CPR. Reasons for the best efficacy of chest compression-only CPR include a better willingness to start CPR by bystanders, the low quality of mouth-to-mouth ventilation and a detrimental effect of too long interruptions of chest compressions during ventilation. Based on our findings, compression-only CPR should be recommended as the preferred CPR technique performed by untrained bystander.

Keywords: cardiac arrest; cardiopulmonary resuscitation; compression-only; meta-analysis; randomized trials; systematic review.

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Conflict of interest statement

Conflict of interest No conflict of interest acknoweledged by the authors.

Figures

Table 1
Table 1
Design features and appraisal of the internal validity of included studies. *
Table 2
Table 2
Overall characteristics of 3737 patients who received either Compression-only (1852 patients) or Standard-CPR (1895 patients) for out of hospital cardiopulmonary resuscitation.
Figure 1
Figure 1
Flow chart of the systematic review process (RCT=randomized clinical trial).
Figure 2
Figure 2
Forest plot for the comparison of standard CPR vs compression-only CPR on hospital survival after cardiopulmonary resuscitation.
See this image and copyright information in PMC

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