Chest compression-only vs standard CPR in adults with out-of-hospital cardiac arrest (OHCA): Cardiac and neurological outcomes.

Decline in rescue breathing and its impact on outcomes in pediatric out-of-hospital cardiac arrest due to drowning: a nationwide study, 2012-2023.

Survival and Neurologic Performance at 30 Days and Beyond Following Out-of-Hospital Cardiac Arrest Comparing Standard Cardiopulmonary Resuscitation Versus Chest Compression-Only Resuscitation by Bystanders: A Systematic Review and Meta-Analysis.

Sex-based disparities in bystander CPR for out-of-hospital cardiac arrest related to non-prescription drug use

Introduction: The effectiveness of compression-only cardiopulmonary resuscitation (CPR) has been well-documented in cardiac-origin out-of-hospital cardiac arrest (OHCA). However, for non-cardiac etiologies such as drowning, conventional CPR with rescue breathing is recommended in guidelines based primarily on expert opinion, with limited evidence supporting its superiority. Objectives: To evaluate the association between bystander CPR type and neurologically favorable survival in drowning-related OHCA. Methods: This retrospective observational study analyzed nationwide Utstein data from Japan between 2013 and 2021. Drowning-related OHCA patients were categorized into three groups: no bystander CPR, compression-only CPR, and conventional CPR. The primary outcome was neurologically favorable survival at 30 days. Multivariable logistic regression with Firth's bias reduction method was used to adjust for potential confounders including year, gender, age, physician presence, witness status, public-access defibrillation, initial rhythm, airway management, adrenaline administration, and time intervals. Results: Among 29,680 drowning-related OHCA patients, 52.6% received no bystander CPR, 41.7% received compression-only CPR, and 5.6% received conventional CPR. Unadjusted rates of neurologically favorable survival were 0.31%, 2.01%, and 10.43%, respectively. After adjustment for confounders, both compression-only CPR (adjusted odds ratio [AOR]: 3.30, 95% CI: 2.31-4.72, p<0.001) and conventional CPR (AOR: 6.45, 95% CI: 4.19-9.93, p<0.001) were associated with significantly higher odds of neurologically favorable survival compared to no bystander CPR. Conventional CPR showed significantly better outcomes compared to compression-only CPR (AOR: 1.95, p<0.001). Adjusted predicted probabilities were 0.09% (95% CI: 0.06-0.12%) for no bystander CPR, 0.28% (95% CI: 0.21-0.37%) for compression-only CPR, and 0.55% (95% CI: 0.38-0.81%) for conventional CPR. Conclusions: In drowning-related OHCA, both types of bystander CPR were associated with improved neurologically favorable survival. However, conventional CPR with rescue breathing resulted in significantly better outcomes than compression-only CPR. These findings support current guideline recommendations for conventional CPR in drowning-related cardiac arrest.

Compression only CPR and mortality in pediatric out-of-hospital cardiac arrest during COVID-19 pandemic.

Basic Life Support: 2025 International Liaison Committee on Resuscitation Consensus on Science With Treatment Recommendations.

Background and Aims:Compression-only cardiopulmonary resuscitation (CPR) has been shown to be as effective as conventional CPR, and oxygen supplementation during compression-only CPR may be beneficial. The study aimed to compare the arterial oxygen levels achieved while supplementing oxygen through high flow nasal cannula (HFNC) during compression-only CPR and bag-mask ventilation (BMV) during conventional CPR in simulated cardiac arrest scenarios on a high-fidelity simulator.Methods:The study included a simulated cardiac arrest created on a human patient simulator (HPS). The simulation included two sets of scenarios. In Simulation A, cardiac arrest was simulated on HPS, and compression-only CPR was provided by AutoPulse, and oxygen supplementation was provided using HFNC. In Simulation B, chest compression was provided by AutoPulse, and BMV was supplemented with oxygen at 15 L/min at a compression-to-ventilation ratio of 30:2. Both simulation scenarios were evaluated for three different starting PaO2 values: 100 mmHg, 80 mmHg, and 60 mmHg. The change in PaO2 and PAO2 values was recorded every minute for 6 minutes. Statistical analysis was conducted using SPSS Statistics (Version 24.0; IBM, Armonk, NY), and P < 0.05 was considered statistically significant.Results:In Simulation A, at a starting PaO2 of 100 mmHg, there was an increase in the PaO2 at the 2nd minute, which was sustained till the 6th minute. PaO2 values were persistently higher at all time points as compared to Simulation B (P < 0.001). At a starting PaO2 of 80 mmHg, there was no change in PaO2 in Simulation A as compared to a sustained fall in Simulation B (P < 0.001). At the starting PaO2 of 60 mmHg, a decrease in PaO2 was observed in both Simulation A and Simulation B (P = 0.57).Conclusion:In a simulated setting, compression-only CPR with HFNC results in better PaO2 levels compared to conventional CPR with BMV.

Effects of head-up CPR on survival and neurological outcomes: A systematic review.

Previous studies support bystander provision of chest compression-only cardiopulmonary resuscitation (CC-CPR) for out-of-hospital cardiac arrest (OHCA). However, it is unknown whether OHCA secondary to opioid toxicity may benefit from chest compression plus ventilation CPR (CCV-CPR). To examine the association between bystander CPR technique and outcomes among both opioid-associated OHCA (OA-OHCA) and otherwise undifferentiated OHCA. This cohort study (performed from August 1, 2023, to December 31, 2024) analyzed cases of adult emergency medical services-treated OHCA that occurred from December 1, 2014, to March 31, 2020, as identified through the British Columbia Cardiac Arrest Registry. Cases were classified as OA-OHCA based on positive postmortem toxicologic investigations, death certificates, or opioid-specific hospital-based diagnoses. All other cases were classified as undifferentiated OHCA. Favorable neurologic outcome at hospital discharge (cerebral performance category ≤2). A multivariable Utstein-adjusted logistic regression model of complete cases was used to assess the association between bystander CPR technique (CC-CPR [reference] vs both CCV-CPR and no CPR individually) with outcomes. An interaction term between the OA-OHCA and bystander CPR technique was used to estimate associations among OA-OHCA and undifferentiated OHCA cases separately. The study included 10 923 OHCAs. After removing 24 cases only treated with ventilatory support, there were 1343 OA-OHCAs (median [IQR] patient age, 40 [31-50] years; 1015 [76%] male) and 9556 undifferentiated OHCAs (median [IQR] patient age, 70 [58-81] years; 6636 (69%) male). In the OA-OHCA group, bystander CCV-CPR was associated with an increased odds of a favorable neurologic outcome (adjusted odds ratio [AOR], 2.85; 95% CI, 1.21-6.75) when compared with CC-CPR. No association was detected with favorable neurologic outcome (AOR, 1.52; 95% CI, 0.82-2.82) when no CPR was compared with CC-CPR. Among undifferentiated OHCAs, no association was detected with a favorable neurologic outcome (AOR, 1.16; 95% CI, 0.80-1.67) when CCV-CPR was compared with CC-CPR. No CPR was associated with a decreased odds of a favorable neurologic outcome (AOR, 0.69; 95% CI, 0.55-0.87) when compared with CC-CPR. The interaction term was statistically significant (P for interaction = .04). In this cohort study of OHCA, bystander CCV-CPR (compared with CC-CPR) was associated with improved outcomes in opioid-associated OHCA; however, this association was not observed among undifferentiated cardiac arrests. These results suggest that the optimal bystander CPR technique for OA-OHCA and undifferentiated OHCA may differ and that ventilations may improve outcomes in OA-OHCA resuscitation.

This meta-analysis aims to compare chest compression-only cardiopulmonary resuscitation (CO-CPR) with standard CPR (sCPR), which includes mouth-to-mouth ventilation, as potential strategies for managing out-of-hospital cardiac arrest (OHCA). We systematically searched various databases and registries such as MEDLINE, Embase, The Cochrane Library, and Clinicaltrials.gov to retrieve relevant studies. We used the revised Cochrane "Risk of Bias" tool for randomized trials (RoB 2.0) to assess the risk of bias in included studies. Revman 5.4 was used to pool dichotomous outcomes under a random effects model. A total of 4 randomized controlled trials were included in our meta-analysis. Our results indicate that CO-CPR was associated with a significantly increased survival to hospital discharge compared to sCPR [relative risk (RR) 1.22, 95% confidence interval (CI): 1.01 to 1.46] with minimal heterogeneity (I2=0%). No significant difference was observed between the two groups regarding 1-day survival (RR 1.07, 95% CI: 0.94 to 1.23), survival to hospital admission with a good neurological outcome (cerebral performance category 1 or 2) (RR 1.10, 95% CI: 0.80 to 1.51), return of spontaneous circulation (RR 1.05, 95% CI: 0.95 to 1.17), and survival to hospital admission (RR 1.08, 95% CI: 0.93 to 1.25). This meta-analysis found that chest CO-CPR significantly improves survival to hospital discharge compared to sCPR for managing OHCA, while yielding comparable results for other resuscitation outcomes.

Background The impact of the coronavirus disease 2019 (COVID-19) pandemic on out-of-hospital cardiac arrest (OHCA) occurring in this setting remains unclear. Objective The objective of this study is to elucidate the impact of the COVID-19 pandemic on the prehospital characteristics and outcomes of OHCAoccurring in the workplace. Methods This nationwide observational study in Japan was a retrospective analysis and included 16,364 non-emergency medical service witnessed and adult workplace OHCAs. The characteristics and outcomes of workplace OHCAs were compared between the pre-pandemic period (2016-2019) and the pandemic period (2020-2021). Furthermore, subgroup analyses were performed for workplace location (office vs. non-office) and infection burden region. Results During the pandemic period, no significant changes were observed in incidence, public access defibrillation (PAD) provision rates, one-month survival rates, or neurologically favorable survival rates. However, increases were observed for bystander cardiopulmonary resuscitation (CPR) (crude odds rate (cOR), 95% confidence interval (CI): 1.10, 1.02-1.16; P<0.001), particularly compression-only CPR. The multivariable analysis revealed that the impact of the pandemic was similarly seen in an increase in bystander CPR (adjusted OR, 95% CI: 1.14, 1.06-1.22; P<0.001). Furthermore, the monthly changes in only PAD were altered biennially (PAD: P=0.02, bystander CPR: P=0.52, one-month survival: P=0.26, and neurologically favorable one-month survival: P=0.48). Analysis restricted to high-infection burden regions revealed that only the PAD rate decreased (P=0.03). Conclusion The COVID-19 pandemic had no impact on OHCA survival in workplaces and had a limited positive impact on bystander responses. This may be attributed to previous positive CPR training experiences and routine preparation for health crises.

Bystander cardiopulmonary resuscitation and outcomes of mass cardiac arrests caused by a crowd crush.

BackgroundA mnemonic is a cognitive aid frequently used in health-related education. The main goal of this study was to develop and test a 5-finger mnemonic for teaching schoolchildren the theoretical aspects of adult Basic Life Support (BLS) steps, a process rarely described in the context of instructing laypersons.MethodsExperts from the European Resuscitation Council’s Basic Life Support Science and Education Committee (ERC BLS SEC), specializing in teaching adult BLS, participated in the first phase of the pilot study. This phase employed the modified reactive Delphi to develop a 5-finger mnemonic for teaching schoolchildren the theoretical aspects of adult BLS steps, in accordance with the 2021 ERC BLS guidelines. The mnemonic underwent revision rounds based on expert suggestions and was evaluated using a 9-point Likert scale. The process was repeated until there was unanimous approval. In the second phase, a pilot test was conducted with schoolchildren at a summer camp to assess their recall of the 5-finger mnemonic. Following their training in adult BLS steps utilizing the 5-finger mnemonic, schoolchildren were tasked with arranging cards depicting images from the mnemonic both before and after the training.ResultsFrom March to October 2022, a four-round modified reactive Delphi engaged four experts from the ERC BLS SEC. Initial expert consensus was moderate, 6.0 (IQR = 4.5–7.5, min = 1, max = 9), on a scale 1 (“totally disagree”) to 9 (“totally agree”). The experts consensus improved over subsequent rounds, resulting in two final versions of the 5-finger mnemonic. Both versions concentrate on the comprehensive adult BLS, differing only in their approach to cardiopulmonary resuscitation (CPR): one employs a method of 30 chest compressions followed by two rescue breaths, while the other utilizes compression-only CPR. In August 2023, a recall pilot test involved mostly female schoolchildren (12/13, 92.3%). Pre-training, no cards with 5-finger mnemonic content were arranged correctly, but post-training, progress improvement was observed, especially in older schoolchildren (Z = -2.727, p = 0.006).ConclusionsThe pilot study highlights the potential of using tailored educational tools, such as mnemonics, to teach important lifesaving skills to different age groups. This suggests that the 5-finger mnemonic effectively improved schoolchildren’s understanding of the theoretical aspects of adult BLS steps.

Background: Despite the lack of evidence supporting the use of chest compression-only cardiopulmonary resuscitation (CO-CPR) emphasizing the importance of rescue breathing for pediatric out-of-hospital cardiac arrest (OHCA), prehospital CO-CPR is increasing. The COVID-19 pandemic may have led more bystanders to perform CO-CPR, even for pediatric OHCA. However, studies on the dissemination of CO-CPR and outcomes in pediatric OHCA are limited. Hypothesis: Spread of CO-CPR led to increased mortality in pediatric OHCA. Aims: Investigate the mortality of nationwide pediatric OHCA patients with the dissemination of CO-CPR pre- and post-COVID-19. Methods: We conducted a retrospective study using a Utstein-Style population cohort database (Japanese National Registry). Pediatric OHCA patients (≤17 years old) with bystander resuscitation attempts registered between the pre-COVID-19 era (2017-2019) and the post-COVID-19 era (2020-2021) were included. The primary outcome was 30-day mortality after OHCA. The secondary outcome was 30-day poor neurological outcomes, defined as Cerebral Performance Category scores of 3, 4, or 5. We used Poisson regression with robust variance to estimate adjusted risk ratio (aRR) with 95% confidence interval (CI) and the population attributable fraction (PAF, %) with a focus on the post-COVID-19 period. Results: A total of 3,352 pediatric OHCA, 2,023 pre-COVID-19, and 1,329 post-COVID-19 patients received bystander CPR and were registered in the database. CO-CPR was more common than CPR with rescue breathing (RB-CPR) during the pre- and post-COVID-19 periods [pre-COVID-19: 1,356 (67.0%) vs. 667 (33.0%), post-COVID-19: 1,048 (78.9%) vs. 281 (21.1%)]. Comparison of CO-CPR vs. RB-CPR showed increased 30-day mortality in both periods [pre-COVID-19: 1,081/1,356 (79.7%) vs. 420/667 (63.0%), post-COVID-19: 841/1,048 (80.2%) vs. 181/281 (64.4%)]. In the overall cohort, mortality increased with CO-CPR (aRR: 1.16, 95% CI: 1.09-1.23, PAF:1.60%). Due to the increased number of patients receiving CO-CPR, we estimated 21.2 excess deaths over the two-year post-COVID-19 period. Similar results were observed for poor neurological outcome (aRR: 1.10, 95% CI: 1.05-1.16, PAF: 1.10%, excess poor outcome: 14.6]). Conclusion: With the spread of CO-CPR for pediatric OHCA, an estimated 10.6 excess deaths per year attributed to CO-CPR may have occurred in the post-COVID-19 period compared to the pre-COVID-19 period in Japan.

Background: This meta-analysis aims to compare chest compression-only cardiopulmonary resuscitation (CO-CPR) with standard CPR (sCPR), which includes mouth-to-mouth ventilation, as potential strategies for managing out-of-hospital cardiac arrest (OHCA). Methods: We systematically searched various databases and registries such as MEDLINE, Embase, The Cochrane Library, and Clinicaltrials.gov to retrieve relevant studies. We used the revised Cochrane “Risk of bias” tool for randomized trials (RoB 2.0) to assess the risk of bias in included studies. Revman 5.4 was used to pool dichotomous outcomes under a random effects model. Results: A total of 4 RCTs were included in our meta-analysis. Our results indicate that CO-CPR was associated with a significantly increased survival to hospital discharge compared to sCPR (RR 1.22, 95% CI: 1.01 to 1.46) with minimal heterogeneity (I2= 0%). No significant difference was observed between the two groups regarding 1-day survival (RR 1.07, 95% CI: 0.94 to 1.23), survival to hospital admission with a good neurological outcome (CPC 1 or 2) (RR 1.10, 95% CI: 0.80 to 1.51), return of spontaneous circulation (RR 1.05, 95% CI: 0.95 to 1.17), and survival to hospital admission (RR 1.08, 95% CI: 0.93 to 1.25). Conclusion: This meta-analysis found that chest compression-only CPR (CO-CPR) significantly improves survival to hospital discharge compared to standard CPR for managing OHCA while yielding comparable results for other resuscitation outcomes.

BackgroundBystander-initiated cardiopulmonary resuscitation (CPR) can improve survival rates in individuals with out-of-hospital cardiac arrest (OHCA). Two CPR approaches are commonly utilized, standard (S-CPR) with mouth-to-mouth breathing and compression-only (CO-CPR). We conducted a systematic review and meta-analysis to compare clinical outcomes associated with S-CPR versus CO-CPR in OHCA.MethodsA systematic literature search was conducted using PubMed, EMBASE, and the Cochrane Library. Eligible studies included randomized controlled trials (RCTs) focused on adult OHCA patients receiving CO-CPR or S-CPR. Forest plots were generated for pooled data analysis using Review Manager version 5.4. Random-effect analyses were used, and statistical significance was set at p < .05.ResultsFour randomized controlled trials were included in the final analysis, encompassing a total sample size of 4987 patients (2482 in the CO-CPR group and 2505 in the S-CPR group). CO-CPR was associated with significantly improved 1-day survival compared with S-CPR (OR = 1.15; 95% CI: 1.02-1.31; p = .03) and survival to hospital discharge (OR = 1.25; 95% CI: 1.01-1.55; p = .04). No heterogeneity was observed among the studies for either outcome.ConclusionCO-CPR emerges as a promising strategy for improving outcomes in OHCA compared to S-CPR. However, further large-scale RCTs are required to generate more robust evidence.

We introduced systematic training in chest compression-only CPR and automated external defibrillator (AED) use to elementary school students. The questionnaire compared student attitudes towards CPR and their knowledge about it before and after CPR training. To assess the effectiveness of the demonstration method and simulation method among school students. To compare the level of knowledge of demonstration method versus simulation method teaching among school students. A quantitative descriptive study was conducted among school students aged between 14 and 15 years. A self-structured questionnaire’ was administered to 60 school students were used as data collection tool. Participants were selected by a simple random sampling technique. The demographic variable father’s occupation (χ2=9.714, p=0.046) had shown a statistically significant association with the level of knowledge on CPR among school students in the demonstration group at p&lt;0.05 level and the other demographic variables had not shown a statistically significant association with the level of knowledge on CPR among school students in the demonstration group. The overall results showed that simulation-based learning (SBL) is a positive, safe and effective method for nursing students in clinical and simulation room settings to improve the skills and practice of client care.

Little is known about how to effectively increase bystander cardiopulmonary resuscitation (CPR), so we evaluated the 10-year trend of the proportion of bystander CPR in an area with wide dissemination of chest compression-only CPR (CCCPR) training combined with conventional CPR training.Methods and Results: We conducted a descriptive study after a community intervention, using a prospective cohort from September 2010 to December 2019. The intervention consisted of disseminating CCCPR training combined with conventional CPR training in Toyonaka City since 2010. We analyzed all non-traumatic out-of-hospital cardiac arrest (OHCA) patients resuscitated by emergency medical service personnel. The primary outcome was the trend of the proportion of bystander CPR. We conducted multivariate logistic regression models and assessed the adjusted odds ratio (AOR) using a 95% confidence interval (CI) to determine bystander CPR trends. Since 2010, we have trained 168,053 inhabitants (41.9% of the total population of Toyonaka City). A total of 1,508 OHCA patients were included in the analysis. The proportion of bystander CPR did not change from 2010 (43.3%) to 2019 (40.0%; 1-year incremental AOR 1.02 [95% CI: 0.98-1.05]). The proportion of bystander CPR did not increase even after wider dissemination of CPR training. In addition to continuing wider dissemination of CPR training, other strategies such as the use of technology are necessary to increase bystander CPR.

Aim. The high availability of modern information and communication technologies, including the Internet, social networks and mobile devices, creates unique opportunities for widely informing people about the importance, principles and methods of first aid in cardiac arrest. The aim was to assess the completeness and correctness of recommendations for first aid in cardiac arrest presented in open Russian-language web resources. Material and methods. In February 2024, Yandex and Google searched for publicly available web pages in Russian that provided information on principles and methods of first aid in cardiac arrest in adults. The content of the web pages was analyzed using the ERC Research NET checklist for assessing the quality of educational resources on basic cardiopulmonary resuscitation (CPR). Additionally, we determined whether web pages contained unnecessary recommendations. Results. The sample for analysis consisted of 27 unique web pages. An assessment of information quality provided on them showed poor coverage of key internationally recommended principles and methods for first aid in cardiac arrest. In particular, 81,5% of web pages (n=22) did not report on the importance of initiating chest compressions as early as possible, 85,2% (n=23) did not report on the need to minimize pauses in compressions, 37,0% (n=10) and 25,9% (n=7) did not report on the recommended depth and frequency of compressions, respectively, and 22,2% (n=6) did not report on the need to call an ambulance immediately after recognizing cardiac arrest. Only 33,3% (n=9) of resources mentioned the possibility of compression-only CPR by people who do not have artificial respiration skills. In addition, 77,8% of web pages (n=21) contained redundant instructions that contradicted current international recommendations on CPR, and 29,6% of resources (n=8) allowed actions or inactions that clearly threatened the safety of the victim when bystanders provided first aid to cardiac arrest. Conclusion. The quality of publicly available Russian-language web resources on first aid in cardiac arrest is generally unsatisfactory. Open access to low-quality resources creates a risk of many people developing false ideas and making mistakes by bystanders in real emergency situations. There is a need to establish uniform procedures for systematic monitoring and quality assurance of publicly available information explaining the principles and methods of first aid in cardiac arrest.