Compression-Only CPR and Standard CPR Appear to be Similarly Effective for Out-of-Hospital Cardiac Arrest When Performed by Untrained Bystanders

DynaMed Weekly Update - Volume 5, Issue 32

In cases of out-of-hospital cardiac arrest, early cardiopulmonary resuscitation (CPR) initiated before the arrival of trained emergency services may improve a patient’s chances of survival. However, untrained bystanders may be reluctant or unable to correctly perform the rescue breathing portion of standard CPR. Improper rescue breathing may reduce the effectiveness of standard CPR. Observational results have suggested that CPR with chest compression alone may be at least as effective as full CPR when performed by untrained people (Lancet 2007 Mar 17;369(9565):920).

Two recent randomized trials compared these two approaches in patients with suspected cardiac arrest. In both trials, bystanders with no previous CPR experience who were calling for emergency assistance were instructed by dispatchers to perform either compression-only CPR or standard CPR (compression and rescue breathing) prior to the arrival of paramedics. In 1 trial with an analysis of 1,941 patients, survival to hospital discharge was 12.5% in the compression-only group and 11% in the standard group (not significant), with 14.4% vs. 11.5% surviving with favorable neurologic status (not significant) (N Engl J Med 2010 Jul 29;363:423). In the second trial, with an analysis of 1,276 patients, 1-day survival was 24% for compression-only vs. 20.9% for standard CPR (not significant) and 30-day survival was 8.7% vs. 7% (not significant) (N Engl J Med 2010 Jul 29;363:434). The analyses in both trials included only about one-third of the randomized patients due to exclusions following randomization (level 2 [mid-level] evidence).

These results do not suggest that chest compression alone is a substitute for standard CPR performed by trained individuals. However, this simplified approach to resuscitation may make untrained people more likely to start CPR. Medical offices receiving emergency calls from families of patients might wish to consider compression-only CPR as an immediate intervention.

For more information, see the Cardiac arrest topic in DynaMed.