Clinical paperTime-dependent effectiveness of chest compression-only and conventional cardiopulmonary resuscitation for out-of-hospital cardiac arrest of cardiac origin☆
Section snippets
Study design and setting
The All-Japan Utstein Registry of the FDMA is a prospective, nationwide, population-based registry system of OHCA based on the Utstein style.18, 19 This observational study enrolled adult patients aged ≥18 years suffering OHCA, who were treated by EMS personnel and then transported to medical institutions from 1 January 2005 through 31 December 2007. The implementation working group for All-Japan Utstein Registry of the FDMA designed the study protocol, the FDMA collected and managed the data
Results
During these 3 years, 312 319 adult OHCAs were documented. The age-adjusted annual incidence of bystander-witnessed OHCA of presumed cardiac origin in Japan during this study period was 9.6/100 000 person-years. The first documented rhythm was VF in 27% (2.6/100 000 person-years).
Fig. 1 shows an overview of the arrests. Out of 307 819 adult OHCA cases with resuscitation attempts, 168 737 were presumed to be of cardiac origin. Of these victims, 55 187 were witnessed by bystanders, 13 024 were witnessed
Discussion
The data from this large nationwide registry of OHCA establish that bystander-initiated conventional CPR with rescue breathing can improve the rate of survival with favourable neurological outcome following OHCA of prolonged duration compared with either no CPR or compression-only CPR. In addition, this investigation confirms that both compression-only CPR and conventional CPR similarly improve outcomes from OHCAs compared with no CPR when the bystander CPR interval is <15 min, and extends these
Conclusions
This nationwide population-based observational study indicates that conventional CPR with rescue breathing had incremental benefit compared with either no CPR or compression-only CPR for very prolonged witnessed OHCAs of cardiac origin, but the absolute survival was low, regardless of type of CPR. Present data also demonstrated that compression-only CPR was as effective as conventional CPR for most adult-witnessed OHCA of cardiac origin.
Conflict of interest statement
There are no conflicts of interest to declare.
Role of funding source
This study was supported by the grant for emergency management scientific research from the Fire and Disaster Management Agency (study concerning strategy for applying the results of the Utstein report for improvement of emergency service), and partially by a Grant-in-Aid for Scientific Research (19390458) from the Ministry of Education, Culture, Sports, Science and Technology.
Acknowledgements
We are greatly indebted to all of the EMS personnel and concerned physicians in Japan, and to the Fire and Disaster Management Agency and Institute for Fire Safety and Disaster Preparedness of Japan for their generous co-operation in establishing and maintaining the Utstein database.
References (37)
- et al.
Quality and efficiency of bystander CPR: Belgian Cerebral Resuscitation Study Group
Resuscitation
(1993) - et al.
Bystander initiated actions in out-of-hospital cardiopulmonary resuscitation: results from the Amsterdam Resuscitation Study (ARRESUST)
Resuscitation
(2001) - et al.
Conventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have out-of-hospital cardiac arrests: a prospective, nationwide, population-based cohort study
Lancet
(2010) - et al.
Effectiveness of simplified chest compression-only CPR training for the general public: a randomized controlled trial
Resuscitation
(2008) Compression-only CPR—to teach or not to teach?
Resuscitation
(2009)- et al.
Survival and neurologic outcome after cardiopulmonary resuscitation with four different chest compression-ventilation ratios
Ann Emerg Med
(2002) - et al.
Does the compression to ventilation ratio affect the quality of CPR: a simulation study
Resuscitation
(2002) - 2005 AHA guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2005;112(24...
- et al.
Temporal trends in sudden cardiac arrest: a 25-year emergency medical services perspective
Circulation
(2003) - et al.
Continuous improvements of chain of survival increased survival after out-of-hospital cardiac arrests: a large-scale population-based study
Circulation
(2009)
Nationwide public access defibrillation in Japan
N Engl J Med
Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observation study
Lancet
Effectiveness of bystander-initiated cardiac-only resuscitation for patients with out-of-hospital cardiac arrest
Circulation
Survival is similar after standard treatment and chest compression only in out-of-hospital bystander cardiopulmonary resuscitation
Circulation
Cardiopulmonary resuscitation by chest compression alone or with mouth-to-mouth ventilation
N Engl J Med
CPR with chest compression alone or with rescue breathing
N Engl J Med
Compression-only CPR or standard CPR in out-of-hospital cardiac arrest
N Engl J Med
Hands-only (compression-only) cardiopulmonary resuscitation: a call to action for bystander response to adults who experience out-of-hospital sudden cardiac arrest: a science advisory for the public from the American Heart Association Emergency Cardiovascular Care Committee
Circulation
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2019, American Journal of Emergency MedicineCitation Excerpt :In Japan, the fire departments of each municipality provide EMS. The Fire and Disaster Management Agency of Japan supervises the nationwide EMS system [12,20,21]. Each region has its own medical direction teams, which comprise fire agencies, local medical associations, local government, and emergency hospitals.
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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2010.09.468.