Compression-only Compression-only Cardiopulmonary Resuscitation Research Articles

Compression-Only or Standard Cardiopulmonary Resuscitation for Trained Laypersons in Out-of-Hospital Cardiac Arrest: A Nationwide Randomized Trial in Sweden.

The ongoing TANGO2 (Telephone Assisted CPR. AN evaluation of efficacy amonGst cOmpression only and standard CPR) trial is designed to evaluate whether compression-only cardiopulmonary resuscitation (CPR) by trained laypersons is noninferior to standard CPR in adult out-of-hospital cardiac arrest. This pilot study assesses feasibility, safety, and intermediate clinical outcomes as part of the larger TANGO2 survival trial. Emergency medical dispatch calls of suspected out-of-hospital cardiac arrest were screened for inclusion at 18 dispatch centers in Sweden between January 1, 2017, and March 12, 2020. Inclusion criteria were witnessed event, bystander on the scene with previous CPR training, age above 18 years of age, and no signs of trauma, pregnancy, or intoxication. Cases were randomized 1:1 at the dispatch center to either instructions to perform compression-only CPR (intervention) or instructions to perform standard CPR (control). Feasibility included evaluation of inclusion, randomization, and adherence to protocol. Safety measures were time to emergency medical service dispatch CPR instructions, and to start of CPR, intermediate clinical outcome was defined as 1-day survival. Of 11 838 calls of suspected out-of-hospital cardiac arrest screened for inclusion, 2168 were randomized and 1250 (57.7%) were out-of-hospital cardiac arrests treated by the emergency medical service. Of these, 640 were assigned to intervention and 610 to control. Crossover from intervention to control occurred in 16.3% and from control to intervention in 18.5%. The median time from emergency call to ambulance dispatch was 1 minute and 36 s (interquartile range, 1.1-2.2) in the intervention group and 1 minute and 30 s (interquartile range, 1.1-2.2) in the control group. Survival to 1 day was 28.6% versus 28.4% (P=0.984) for intervention and control, respectively. In this national randomized pilot trial, compression-only CPR versus standard CPR by trained laypersons was feasible. No differences in safety measures or short-term survival were found between the 2 strategies. Efforts to reduce crossover are important and may strengthen the ongoing main trial that will assess differences in long-term survival. URL: https://www.clinicaltrials.gov; Unique identifier: NCT02401633.

Annual improvement trends in resuscitation outcome of patients defibrillated by laypersons after out-of-hospital cardiac arrests and compression-only resuscitation of laypersons

AimWe aimed to investigate the effect of compression-only cardiopulmonary resuscitation (CPR) with conventional CPR in patients who were defibrillated by laypersons. MethodsThis is a population-based, nationwide observational study. Adult and children who sustained a witnessed out-of-hospital cardiac arrest and defibrillated by laypersons between 2005 to 2019 were identified on the national database. The study used trend analyses, multivariate logistic regression, and inverse probability weighting using propensity score to explore changes in one-month survival and survival with a good neurological outcome over time and the influence of compression-only CPR compared with conventional CPR. ResultsIn total, 11,402 patients defibrillated by laypersons were enrolled in this study. The percentages of compression-only resuscitation increased dramatically and more than 50% from 2012 (P < 0.001). The percentages of cases with favorable resuscitation outcomes also increased annually (P < 0.001). By regression analysis, favorable outcomes were associated with recent years, male sex, younger age, and shorter resuscitation start time. In addition, the adjusted odds ratio of compression-only CPR to conventional CPR was 1.23 with a 95% confident interval 1.13–1.34. By inverse probability weighting, compression-only CPR was superior to conventional CPR for the favorable outcomes (P < 0.001). The adjusted outcomes in each year were better in compression-only resuscitation in most of the years. The overall relative risk reduction and the number needed to treat for compression-only resuscitation compared with conventional resuscitation were 7.6% and 22.1, respectively. ConclusionsIn Japan, the outcomes of out-of-hospital cardiac arrest patients who were defibrillated by laypersons were considerably better in compression-only resuscitation of laypersons every year.

Abstract 204: Conventional vs. Compression-Only Cardiopulmonary Resuscitation for Geriatric Out-of-Hospital Cardiac Arrest

Introduction: Compression-only cardiopulmonary resuscitation (CPR) and conventional CPR (30:2, chest compression and rescue breathing) performed by bystanders are known to have similar outcomes in adults. This study aimed to investigate if this difference is applicable in geriatric populations as well. Methods: We conducted a prospective observational study using the All-Japan Utstein Registry to enroll geriatric patients (≥75 years) who experienced out-of-hospital cardiac arrest that was witnessed by bystanders in Japan from January 1, 2009 to December 31, 2013. The primary outcome was favorable neurological function 1 month after the event, which was defined as a Cerebral Performance Category Scale score of 1 or 2. The secondary outcomes were return of spontaneous circulation (ROSC), 1-month survival, and favorable overall function 1 month after the event, which was defined as an Overall Performance Category Scale score of 1 or 2. Outcomes of compression-only CPR and conventional CPR were compared using multivariable logistic regression analyses. Results: Of the 58,072 enrolled patients, 13,248 (22.8%) received conventional CPR whereas 44,824 (77.2%) received compression-only CPR. Favorable neurological outcomes were achieved in 708 (5.3%) patients receiving CPR and 1799 (4.0%) patients receiving compression-only CPR. A crude analysis of neurologically favorable survival revealed superiority of conventional CPR [odds ratio (OR), 1.35; 95% confidence interval (CI), 1.24–1.48; P &lt; 0.001]], but it was no longer statistically significant after multivariable adjustment (OR, 1.09; 95% CI, 0.93–1.27; P = 0.29). Similarly, multivariable adjusted analysis of favorable overall function survival showed no significant difference (OR, 1.08; 95% CI, 0.92–1.26; P = 0.38) between conventional and compression-only CPR. Conventional CPR demonstrated better outcomes in multivariable adjusted analysis of ROSC and 1 month survival (OR, 1.30; 95% CI, 1.22–1.40; P &lt; 0.001 and OR, 1.13. 95% CI, 1.04–1.23; P = 0.003, respectively). Conclusions: The superiority of conventional CPR in geriatric populations was not proven. Thus, we conclude that compression-only CPR is an adequate means of resuscitation in geriatric populations.

A Public Health Response to the Poor Outcomes in Out-of-Hospital Cardiac Arrests in Australia

The high incidence and poor outcomes for those who suffered out-of-hospital cardiac arrests, plus the knowledge that early bystander treatment improves outcomes, called for a public health response to this issue. The ‘Shock Verdict’ National CPR Campaign sought to improve the rates of bystander compression-only cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use, through a social media public health awareness campaign. An 8-week social media campaign centred around an educational video based on a popular Australian comedy drama ‘Rake’ was designed and developed through a partnership between the Tasmanian Branch of the Australian Resuscitation Council and the University of Tasmania. To date, there have been over 1 million views on the various social media platforms. The campaign focuses on how untrained bystanders can perform compression-only CPR and use an AED in out-of-hospital cardiac arrest, to increase chances of survival. Baseline data collected from an online survey found approximately 50% of respondents rated their CPR knowledge and their confidence to perform CPR as good or fair. Participants were more likely to report a willingness to start hands-only CPR on strangers and unkempt individuals than standard CPR. The campaign provides an example of using social media to communicate a health message, and demonstrates the practicalities of planning such a campaign, including the design of content, and building partnerships. It highlights the importance of collaboration between academic research, health and marketing, and of applying a public health approach to improving clinical outcomes.

Passive ultra-brief video training improves performance of compression-only cardiopulmonary resuscitation

BackgroundBystander compression-only cardiopulmonary resuscitation (CPR) improves survival after out-of-hospital cardiac arrest. To broaden CPR training, 1–2min ultra-brief videos have been disseminated via the Internet and television. Our objective was to determine whether participants passively exposed to a televised ultra-brief video perform CPR better than unexposed controls. MethodsThis before-and-after study was conducted with non-patients in an urban Emergency Department waiting room. The intervention was an ultra-brief CPR training video displayed via closed-circuit television 3–6 times/hour. Participants were unaware of the study and not told to watch the video. Pre-intervention, no video was displayed. Participants were asked to demonstrate compression-only CPR on a manikin. Performance was scored based on critical actions: check for responsiveness, call for help, begin compressions immediately, and correct hand placement, compression rate and depth. The primary outcome was the proportion of participants who performed all actions correctly. ResultsThere were 50 control and 50 exposed participants. Mean age was 37, 51% were African-American, 52% were female, and 10% self-reported current CPR certification. There were no statistically significant differences in baseline characteristics between groups. The number of participants who performed all actions correctly was 0 (0%) control vs. 10 (20%) exposed (difference 20%, 95% confidence interval [CI] 8.9–31.1%, p<0.001). Correct compression rate and depth were 11 (22%) control vs. 22 (44%) exposed (22%, 95% CI 4.1–39.9%, p=0.019), and 5 (10%) control vs. 15 (30%) exposed (20%, 95% CI 4.8-35.2%, p=0.012), respectively. ConclusionPassive ultra-brief video training is associated with improved performance of compression-only CPR.

가슴압박만 하는 심폐소생술과 30 : 2 표준 심폐소생술 방법에 의한 가슴압박 질의 비교

Purpose : This study aimed to compare the chest compression quality bet ween compression-only cardiopulmonary resuscitation (CPR) and conventional CPR.Methods : This study involved 123 participants randomly assigned to eit her the chest compression-only CPR training and conventional CPR training. After training for 120 min, the participants performed CPR for 4 min and the CPR quality was evaluated. The primary ou tcome was evaluated as the mean compression depth, and the secondary outcome was calculated as the proportion of chest compressions with an appropriate depth among the total chest compressions.Results : The mean compression depth was more deeper in conventional CPR than in compression-only CPR (57mm vs. 53mm, p＜.001). The proportion of appropriate chest compression depth w as also more higher in conventional CPR (98.8% vs. 68.6%, p＜.001). As compared with every minute over time for a total of 4 min, the mean compression depth and the proportion of appropriate chest compression depth were deeper and higher after 1 min in conventional CPR than in compression-only CPR. Conclusion : The results suggested that conventional CPR is a better metho d than compression-only CPR in terms of chest compression quality. Keywords : Cardiopulmonary resuscitation, Chest compression, DepthReceived October 27, 2015 Revised December 1, 2015 Accept ed December 21, 2015

Dispatcher instruction of chest compression-only CPR increases actual provision of bystander CPR

BackgroundA preceding randomized controlled trial demonstrated that chest compression-only cardiopulmonary resuscitation (CPR) instruction by dispatcher was more effective to increase bystander CPR than conventional CPR instruction. However, the actual condition of implementation of each type of dispatcher instruction (chest compression-only CPR [CCCPR] or conventional CPR with rescue breathing) and provision of bystander CPR in real prehospital settings has not been sufficiently investigated. MethodsThis registry prospectively enrolled patients aged =>18 years suffering an out-of-hospital cardiac arrest (OHCA) of non-traumatic causes before emergency-medical-service (EMS) arrival, who were considered as target subjects of dispatcher instruction, resuscitated by EMS personnel, and transported to medical institutions in Osaka, Japan from January 2005 through December 2012. The primary outcome measure was provision of CPR by a bystander. Multiple logistic regression analysis was used to assess factors that were potentially associated with provision of bystander CPR. ResultsAmong 37,283 target subjects of dispatcher instruction, 5743 received CCCPR instruction and 13,926 received conventional CPR instruction. The proportion of CCCPR instruction increased from 5.7% in 2005 to 25.6% in 2012 (p for trend <0.001). The CCCPR instruction group received bystander CPR more frequently than conventional CPR instruction group (70.0% versus 62.1%, p<0.001). In the multivariable analysis, CCCPR dispatcher instruction was significantly associated with provision of bystander CPR compared with conventional CPR instruction (adjusted odds ratio 1.44, 95% CI 1.34–1.55). ConclusionsCCCPR dispatcher instruction among adult OHCA patients significantly increased the actual provision of bystander CPR.

Compression-only cardiopulmonary resuscitation vs standard cardiopulmonary resuscitation: an updated meta-analysis of observational studies

ObjectivesTo perform an updated meta-analysis of observational studies with unstratified cohort addressing whether compression-only cardiopulmonary resuscitation (CPR), compared with standard CPR, improves outcomes in adult patients with out-of-hospital cardiac arrest and a subgroup meta-analysis for the patients with cardiac etiology arrest. MethodsWe searched the relevant literature from MEDLINE and EMBASE databases. The baseline information and outcome data (survival to hospital discharge, favorable neurologic outcome at hospital discharge, and return of spontaneous circulation on hospital arrival) were extracted both in an out-of-hospital cardiac arrest and cardiac origin arrest subgroup. Meta-analyses were performed by using Review Manager 5.0. ResultsEight studies involving 92 033 patients were eligible. Overall meta-analysis showed that standard CPR was associated with statistically improved survival to hospital discharge (risk ratio [RR], 0.95 [95% confidence interval, 0.91-0.99]) and return of spontaneous circulation on hospital arrival (RR, 0.95 [95% confidence interval, 0.92-0.99]) compared with compression-only CPR, but there is no significant difference in favorable neurologic outcome at hospital discharge between 2 CPR methods (RR, 0.97 [95% confidence interval, 0.91-1.04]). In the subgroup of patients with a cardiac cause of arrest, the pooled meta-analysis found compression-only CPR resulted in the similar survival to hospital discharge as standard CPR (RR, 0.99 [95% confidence interval, 0.94-1.05]). ConclusionsThis meta-analysis found that compression-only CPR resulted in the similar survival rate as the standard CPR in the cardiac etiology subgroup. It is unclear for the patients with noncardiac cause of arrest and with long periods of untreated arrest.

Anesthesia Literature Review

Anesthesia Literature Review

Bystander-Initiated Rescue Breathing for Out-of-Hospital Cardiac Arrests of Noncardiac Origin

Although chest compression-only cardiopulmonary resuscitation (CPR) is effective for adult out-of-hospital cardiac arrest (OHCA) of cardiac origin, it remains uncertain whether bystander-initiated rescue breathing has an incremental benefit for OHCA of noncardiac origin. A nationwide, prospective, population-based, observational study covering the whole population of Japan and involving consecutive OHCA patients with emergency responder resuscitation attempts was conducted from January 2005 through December 2007. The primary outcome was neurologically intact 1-month survival. Multiple logistic regression analysis was used to assess the contribution of bystander-initiated CPR to better neurological outcomes. Among a total of 43 246 bystander-witnessed OHCAs of noncardiac origin, 8878 (20.5%) received chest compression-only CPR, and 7474 (17.3%) received conventional CPR with rescue breathing. The conventional CPR group (1.8%) had a higher rate of better neurological outcome than both the no CPR group (1.4%; odds ratio, 1.58; 95% confidence interval, 1.28 to 1.96) and the compression-only CPR group (1.5%; odds ratio, 1.32; 95% confidence interval, 1.03 to 1.69). However, the compression-only CPR group did not produce better neurological outcome than the no CPR group (odds ratio, 1.19; 95% confidence interval, 0.96 to 1.47). The number of OHCAs needed to treat with conventional CPR versus compression-only CPR to save a life with favorable neurological outcome after OHCA was 290. This nationwide observational study indicates that rescue breathing has an incremental benefit for OHCAs of noncardiac origin, but the impact on the overall survival after OHCA was small.

Quality of chest compressions during continuous CPR; comparison between chest compression-only CPR and conventional CPR

Objectives This study aimed to compare the time-dependent deterioration of chest compressions between chest compression-only cardiopulmonary resuscitation (CPR) and conventional CPR. Methods This study involved 106 and 107 participants randomly assigned to chest compression-only CPR training and conventional CPR training, respectively. Immediately after training, participants were asked to perform CPR for 2 min and the quality of their CPR skills were evaluated. The number of chest compressions in total and those with appropriate depth were counted every 20-s CPR period from the start of CPR. The primary outcome was the CPR quality index calculated as the proportion of chest compressions with appropriate depth among total chest compressions. Results The total number of chest compressions remained stable over time both in the chest compression-only and the conventional CPR groups. The CPR quality index, however, decreased from 86.6 ± 25.0 to 58.2 ± 36.9 in the chest compression-only CPR group from 0–20 s through 61–80 s. The reduction was greater than in the conventional CPR group (85.9 ± 25.5 to 74.3 ± 34.0). The difference in the CPR quality index reached statistical significance ( p = 0.003) at 61–80 s period. Conclusions Chest compressions with appropriate depth decreased more rapidly during chest compression-only CPR than conventional CPR. We recommend that CPR providers change their roles every 1 min to maintain the quality of chest compressions during chest compression-only CPR. (UMIN-CTR C0000000321)

Effectiveness of simplified chest compression-only CPR training program with or without preparatory self-learning video: A randomized controlled trial

Objectives To evaluate the effectiveness of 1-h practical chest compression-only cardiopulmonary resuscitation (CPR) training with or without a preparatory self-learning video. Methods Participants were randomly assigned to either a control group or a video group who received a self-learning video before attending the 1-h chest compression-only CPR training program. The primary outcome measure was the total number of chest compressions during a 2-min test period. Results 214 participants were enrolled, 183 of whom completed this study. In a simulation test just before practical training began, 88 (92.6%) of the video group attempted chest compressions, while only 58 (64.4%) of the control group ( p < 0.001) did so. The total number of chest compressions was significantly greater in the video group than in the control group (100.5 ± 61.5 versus 74.4 ± 55.5, p = 0.012). The proportion of those who attempted to use an automated external defibrillator (AED) was significantly greater in the video group (74.7% versus 28.7%, p < 0.001). After the 1-h practical training, the number of total chest compressions markedly increased regardless of the type of CPR training program and inter-group differences had almost disappeared (161.0 ± 31.8 in the video group and 159.0 ± 35.7 in the control group, p = 0.628). Conclusions 1-h chest compression-only CPR training makes it possible for the general public to perform satisfactory chest compressions. Although a self-learning video encouraged people to perform CPR, their performance levels were not sufficient, confirming that practical training as well is essential. (UMIN000001046).

Effectiveness of simplified chest compression-only CPR training for the general public: A randomized controlled trial

To compare the quality of resuscitation between those with a simplified chest compression-only cardiopulmonary resuscitation (CPR) program and those with a conventional CPR program. The participants were randomly assigned to either the 120-min training program of chest compressions (chest compression-only CPR) or the 180-min training program of chest compressions and ventilations (conventional CPR). Main outcome measures were the net number of appropriate chest compressions during the 2-min test period and the proportion of appropriate chest compressions over the theoretically attainable number one month after the training. 223 participants were enrolled and 104 in each group completed this study. The 2-min number of appropriate chest compressions was 86.1+/-57.2 in the chest compression-only CPR group, which was significantly greater than 57.1+/-30.2 in the conventional CPR group (p<0.001). The proportion of appropriate chest compressions was higher in the chest compression-only CPR group than in the conventional CPR group (47.1+/-31.1% versus 38.1+/-20.1%, p=0.022). Time without chest compressions during conventional CPR reached 85.5+/-17.0 s out of 120 s, which was significantly longer than that during chest compression-only CPR (33.9+/-10.0 s, p<0.001). The total number of ventilations and the number of appropriate ventilations during 2 min was 2.5+/-3.0 and 0.9+/-1.6, respectively. A simplified chest compression-only CPR program makes it possible for the general public to perform a greater number of appropriate chest compressions than the conventional CPR program (UMIN-CTR C0000000321).