Abstract 2011: Basic Resuscitation with Chest Compression Only for Patients Who Had Out-Of-Hospital Cardiac Arrest Not Witnessed by Bystanders

Abstract

BACKGROUND SOS-KANTO study showed that bystander chest compression-only resuscitation was the preferable approach to resuscitation for adult patients with witnessed out-of-hospital cardiac arrest ( Lancet 2007 ; 369 ), but few clinical studies have focused on the efficacy of basic resuscitation with chest compression only for patients with unwitnessed out-of-hospital cardiac arrest. METHODS SOS-KANTO study was conducted in 58 emergency hospitals and emergency medical service units. On arrival at the scene, paramedics assessed the technique of basic resuscitation and asked additional questions. The primary endpoint was favorable neurological outcome 30 days after cardiac arrest. RESULTS Of the 9,592 patients with out-of-hospital cardiac arrest, 4,347 adult patients with unwitnessed arrest were included; 385 (8.9%) received chest compression-only resuscitation, 507 (11.7%) received chest compression plus mouth-to-mouth ventilation resuscitation, and 3,456 (79.5%) received no resuscitation. Any resuscitation attempt was associated with a higher proportion of the favorable neurological outcome than no resuscitation (1.1% vs. 0.4%, p=0.009). The chest compression-only resuscitation group had higher proportions of the favorable neurological outcome than the no resuscitation group in the whole cohort (1.3% vs. 0.4%, p=0.018) and in the subgroups of patients with cardiac causes (2.0% vs. 0.6%, p=0.018) and with time interval from EMS call to arrival at patient’s side for ≤ 8 min (2.0% vs. 0.6%, p=0.020). However, the chest compression-only resuscitation group had a similar proportion of the favorable neurological outcome than the chest compression plus ventilation resuscitation in the whole cohort (1.3% vs. 1.0%, p=0.662) and there was no evidence for any benefit from the addition of ventilation in any subgroups. The adjusted odds ratios for the favorable neurological outcome after chest compression-only resuscitation and after chest compression plus ventilation resuscitation were 3.4 (95% CI, 1.1 to 10.5, p=0.033) and 3.3 (95% CI, 1.1 to 10.1 p=0.035). CONCLUSIONS Basic resuscitation with chest compression only is the preferable approach to resuscitation even though the adult patients with unwitnessed out-of-hospital cardiac arrest.