Chest-Compression-Only CPR Shows Long-Term Survival Benefit

PARIS, France — The short-term mortality benefit of using chest compressions only rather than chest compressions plus rescue breathing in the resuscitation of patients with out-of-hospital cardiac arrest appears to be continued in the long term, a new study suggests [1].

The study, published online in Circulation on December 10, 2012, was conducted by a team led by Dr Florence Dumas(Descartes University, Paris, France).

They conclude: "The current results provide important evidence that chest-compression alone . . . can achieve better overall prognosis and should be considered the . . . approach for nearly all adult patients for whom dispatchers suspect cardiac arrest."

The researchers combined data from two randomized trials comparing chest compression alone or chest compression plus rescue breathing on short-term mortality and ascertained long-term vital status of patients from national and state death records.

Results showed that among the 2496 subjects there were 2260 deaths and 236 long-term survivors. Randomization to chest compression alone compared with chest compression plus rescue breathing was associated with a lower risk of death in the long term (one, three, and five years) after adjustment for potential confounders (adjusted HR=0.91; 95% CI 0.83–0.99).

"Meaningful Long-Term Public-Health Benefits"

The authors say that they had expected that the early survival difference may have been amplified after hospital discharge, but this was not seen. Rather, the long-term survival benefit of the chest-compressions-alone approach appeared to be attributable entirely to an early survival differential that persisted over subsequent years of follow-up, with the survival curves during long-term follow-up running parallel. But these results still suggest that short-term-outcome differences do translate to meaningful long-term public-health benefits, they add.

It has previously been suggested that chest compressions alone would be beneficial only for patients with collapse of cardiac origin and those with a shockable rhythm. Subgroup analysis of the current data, while not statistically definitive, supports this view, but there was no evidence of harm among those for whom oxygenation and ventilation might in theory be more important such as noncardiac etiology or unwitnessed arrest, the paper notes.

The authors add: "The results are specific to dispatcher-assisted layperson CPR, though they provide a useful context to consider layperson CPR training and guidelines."

Noting that laypersons are often especially challenged to perform effective rescue breathing even after training, they conclude that the current results "support the 2010 guidelines that prioritize chest compressions regardless of training status or dispatcher assistance."