COMPRESSION-only cardiopulmonary resuscitation (CPR) by untrained bystanders is not a panacea for out-of-hospital cardiac arrest but is better than nothing, according to the chairman of the Australian Resuscitation Council (ARC), Professor Ian Jacobs.
Professor Jacobs said promoting the use of “hands only” CPR did not take into account the increasing number of cardiac arrests associated with lack of oxygen.
Media coverage last week on the use of compression-only CPR (COCPR) followed a new study in JAMA that found bystander COCPR was associated with increased survival compared with bystander traditional CPR and no CPR in out-of-hospital cardiac arrests.(1)
Professor Jacobs said the number of cardiac arrests due to trauma, drug overdose, asphyxia or drowning was increasing and responded better to traditional CPR with ventilation.
However, he said the fact that two-thirds of people who had an out-of-hospital cardiac arrest still received no resuscitation was “a big take-home message”.
Figures from the National Heart Foundation (NHF) show that, in Australia, up to 30 000 adults have cardiac arrests each year but 70% to 80% do not receive CPR.
Professor Jacobs said the ARC, Australia’s peak body responsible for developing resuscitation guidelines, will push for a campaign to promote COCPR by untrained bystanders who witness an out-of-hospital cardiac arrest.
He said an educational program was “absolutely” needed to encourage people to do CPR without mouth-to-mouth rescue breathing.
Current ARC guidelines recommend that where a rescuer is untrained or unwilling to perform traditional CPR, they should use uninterrupted chest compressions.
Professor Jacobs said COCPR was most effective if applied early in cardiac arrest due to an underlying cardiac cause.
The ARC, Australasian College for Emergency Medicine (ACEM), National Heart Foundation (NHF), St John Ambulance, Australian Red Cross and other groups unanimously agree that any attempt at resuscitation is better than none.
Dr Peter Leman, of ACEM, said patients who had an out-of-hospital cardiac arrest had a poor prognosis and any technique that might improve survival chances was welcome.
In the JAMA study of 4415 patients in Arizona with out-of-hospital cardiac arrest between 2005 and 2009, bystander COCPR was associated with increased survival compared with bystander traditional CPR and no CPR.
The research was done after Arizona introduced a program in 2005 to encourage bystanders to use COCPR.
Bystanders providing any type of CPR increased from 28.2% to 39.9%, after the program was introduced, and overall survival increased from 3.7% to 9.8%.
Neurological outcomes were similar for both forms of CPR.
Other key findings of the study were that among patients who received bystander CPR, the proportion with COCPR jumped from about 20% to 76%.
An editorial in JAMA said new United States guidelines for 2010 were likely to suggest COCPR by non-medical bystanders was at least equivalent, if not superior, to standard CPR.(2)
NHF chief medical adviser, Professor James Tatoulis, said the evidence for COCPR was very compelling and the NHF could help facilitate any campaign to promote it.
“There are also scientific data [to show] that if there are no interruptions to blood supply by continuously compressing the heart effectively, then you are probably better off [not to] … interrupt it every now and again [to do ventilation],” Professor Tatoulis said.
Many bystanders were reluctant to perform traditional CPR because they found mouth-to-mouth “unsavoury”, feared infection or harming the patient, panicked or thought the procedure too complex, he said.
2. JAMA 2010; 304: 1493-1495.
Posted 11 October 2010