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CPR with Chest Compression Alone Beneficial

Results from a recent animal study (see Circulation 1997; 96:4364) suggested that chest compression alone might be as effective as chest compression plus ventilation for the immediate treatment of ventricular fibrillation. In this randomized trial, investigators from the University of Washington compared both methods of cardiopulmonary resuscitation (CPR). Fire department dispatchers instructed untrained bystanders in CPR either with or without mouth-to-mouth ventilation until the emergency services team arrived.

Of 1296 episodes of presumed cardiac arrest, 776 were excluded, including those that resulted from drug overdose, alcohol intoxication, or carbon monoxide poisoning, or those in which advanced cardiac life support had not been provided. Of the remaining 520 cases, 279 were randomized to chest compression plus mouth-to-mouth ventilation and 241 to chest compression alone. Patient and episode characteristics were similar in the 2 groups.

Chest compression alone required 1.4 fewer minutes of instruction than did compression plus mouth-to-mouth ventilation. Overall, the survival rate to hospital discharge was higher among patients who received chest compression alone (14.6 percent vs. 10.4 percent, P=0.18).

Comment: These intriguing results suggest that a strategy of chest compression alone for bystander-initiated CPR is no worse -- and may even be better -- than the conventional approach of chest compression plus mouth-to-mouth ventilation. This important study will influence the current paradigm by enabling more bystanders to participate in CPR without fear of potentially transmitting or contracting communicable diseases.

— HM Krumholz

Published in Journal Watch Cardiology August 4, 2000

Citation(s):

Hallstrom A et al. Cardiopulmonary resuscitation by chest compression alone or with mouth-to-mouth ventilation. N Engl J Med 2000 May 25 342 1546-1553.

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