Endorsing chest compression-only CPR increases both CPR rates and survival

By Melanie Hinze
A Swedish nationwide study has found that endorsing chest compression-only CPR in guidelines is associated with improved out-of-hospital CPR rates and better overall survival rates.

The study, published in Circulation, found that although there was a small but significantly higher chance of survival after standard CPR (ventilations and compressions) compared with compression-only CPR, any CPR doubled survival rates compared with no CPR. As such, the study authors concluded that their findings supported continued endorsement of compression only CPR as an option in future CPR guidelines.

Professor Tony Celenza, Chair of the Western Australian branch of the Australian Resuscitation Council agreed, saying, ‘One of the phrases often used by the Australian Resuscitation Council is, “Any attempt at resuscitation is better than no attempt.”

‘This Swedish study reinforces this message with results showing far fewer survivors if CPR is not performed.’

Professor Celenza, a consultant emergency physician and Head of the Division of Emergency Medicine at the University of Western Australia said that in this study, standard CPR had a slightly higher survival rate than compression-only CPR. ‘However, if a higher proportion of bystanders are willing to perform compression-only CPR, then the overall benefit to the community is larger,’ he said.

‘Compression-only CPR also has advantages in terms of being easier to learn and easier to perform and it has less personal concerns than mouth-to-mouth ventilation.’

The study included 30,445 patients who experienced bystander witnessed out-of-hospital cardiac arrests that were reported to the Swedish register for CPR between 2000 and 2017. This incorporated three different guideline time periods: 2000 to 2005, 2006 to 2010 and 2011 to 2017.

Over time, the proportion of patients receiving CPR before emergency medical services arrived increased from 40.8% in the first time period, to 58.8% in the second and to 68.2% in the third. Standard CPR rates changed from 35.4% to 44.8% to 38.1%, and chest compression-only CPR rates increased from 5.4% to 14% to 30.1% in the three guideline time periods.

Thirty-day survival changed from 3.9% to 6.0% to 7.1% in the no CPR group, from 9.4% to 12.5% to 16.2% in the standard CPR group, and from 8.0% to 11.5% to 14.3% in the compression-only CPR group in the three time periods.

Professor Celenza added that for patients who have had a cardiac arrest due to lack of oxygen (more often in children and young adults and in circumstances such as drownings) then he would still promote standard CPR if the bystander has been trained and is willing to perform it.
Circulation 2019; 139: 00-00; doi: 10.1161/CIRCULATION AHA.118.038179.