News Release

Resuscitation practices need to be revised for cardiac arrest

Peer-Reviewed Publication

The Lancet_DELETED

Bystander cardiac-only resuscitation* has a better outcome for patients with out-of-hospital cardiac arrest than conventional cardiopulmonary resuscitation (CPR), according to an Article published in this week’s issue of The Lancet.

Cardiopulmonary resuscitation (CPR) consisting of chest compression plus mouth-to-mouth ventilation done by bystanders is a major factor in the survival for people with cardiac arrest. However, surveys have identified a reluctance of bystanders to undertake mouth-to-mouth ventilation because of a fear of transmission of infectious disease and the complexity of the CPR technique as it is presently taught. But few clinical studies have investigated the efficacy of bystander resuscitation by chest compressions without mouth-to-mouth ventilation (cardiac-only resuscitation).

Ken Nagao (Surugadai Nihon University Hospital, Tokyo, Japan) and colleagues compared the outcomes for over 4000 adult patients who underwent cardiac-only resuscitation or conventional CPR by bystanders in an observational study. The authors found that cardiac-only resuscitation resulted in a better outcome than conventional CPR in terms of neurological benefit especially in patients with apnoea (6.2% vs 3.1%), and those with shockable cardiac rhythm (19.4% vs 11.2%) or short periods of untreated arrest** (10.1% vs 5.1%). Furthermore there was no evidence for any benefit from the addition of mouth-to-mouth ventilation in any subgroup of patients.

The authors conclude: " Bystander cardiac-only resuscitation is the preferred approach to resuscitation for adult patients with witnessed out-of-hospital cardiac arrest especially those with apnoea, shockable cardiac rhythm, or short periods of untreated arrest…[on the basis of these findings] rescuers might be more willing and able to provide this simple intervention than they are at present".

In an accompanying Comment, Gordon Ewy (University of Arizona College of Medicine and Sarver Heart Center, Tucson, USA) states: "This critically important finding…should lead to changes in guidelines. Advocating, encouraging, and teaching chest-compression-only for witnessed unexpected sudden collapse will dramatically increase bystander-initiated resuscitation efforts and thereby give these patients a better chance of survival when emergency personnel arrive. We should continue instructions in cardiopulmonary resuscitation for the equally important, but less frequent, occurrences of drowning and other forms of respiratory arrest."

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EMBARGO: 00:01H (UK time) Friday March 16, 2007.

Notes to Editors
*Cardiac-only resuscitation—chest compression without mouth-to-mouth ventilation.
** CPR that started within 4 min of arrest.

Dr Ken Nagao, Surugadai Nihon University Hospital, Tokyo, Japan. T) +81 332 931 711 kennagao@med.nihon-u.ac.jp

Comment Professor Gordon Ewy, University of Arizona College of Medicine and Sarver Heart Center, Tucson, USA. T) +1 520 626 2000 gaewy@aol.com


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