Elsevier

Resuscitation

Volume 82, Issue 1, January 2011, Pages 3-9
Resuscitation

Clinical paper
Time-dependent effectiveness of chest compression-only and conventional cardiopulmonary resuscitation for out-of-hospital cardiac arrest of cardiac origin

https://doi.org/10.1016/j.resuscitation.2010.09.468Get rights and content

Abstract

Background

Little is known about the effect of the type of bystander-initiated cardiopulmonary resuscitation (CPR) for prolonged out-of-hospital cardiac arrest (OHCA).

Objectives

To evaluate the time-dependent effectiveness of chest compression-only and conventional CPR with rescue breathing for witnessed adult OHCA of cardiac origin.

Methods

A nationwide, prospective, population-based, observational study of the whole population of Japan included consecutive OHCA patients with emergency responder resuscitation attempts from 1 January 2005 to 31 December 2007. Multiple logistic regression analysis was performed to assess the contribution of the bystander-initiated CPR technique to favourable neurological outcomes.

Results

Among 55 014 bystander-witnessed OHCA of cardiac origin, 12 165 (22.1%) received chest compression-only CPR and 10 851 (19.7%) received conventional CPR. For short-duration OHCA (0–15 min after collapse), compression-only CPR had a higher rate of survival with favourable neurological outcome than no CPR (6.4% vs. 3.8%; adjusted odds ratio (OR), 1.55; 95% confidence interval (CI), 1.38–1.74), and conventional CPR showed similar effectiveness (7.1% vs. 3.8%; adjusted OR, 1.78; 95% CI, 1.58–2.01). For the long-duration arrests (>15 min), conventional CPR showed a significantly higher rate of survival with favourable neurological outcome than both no CPR (2.0% vs. 0.7%; adjusted OR, 1.93; 95% CI, 1.27–2.93) and compression-only CPR (2.0% vs. 1.3%; adjusted OR, 1.56; 95% CI, 1.02–2.44).

Conclusions

For prolonged OHCA of cardiac origin, conventional CPR with rescue breathing provided incremental benefit compared with either no CPR or compression-only CPR, but the absolute survival was low regardless of type of CPR.

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.

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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.

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