UPDATE ON CHEST COMPRESSION ONLY CPR FOR WITNESS CARDIAC ARREST VICTIMS



Mohammad-Reza Movahed, M.D., Ph.D., CareMore, University of Arizona, College of Medicine, Tucson, AZ, USA

Absence of bystander-initiated resuscitation efforts, survival is rare. Yet the greatest impediment to the initiation of bystander resuscitation efforts is the aversion to or the complicated nature of mouth-to-mouth resuscitation. This is why our group in Arizona has been advocating chest-compression-alone bystander resuscitation since the early 1990s. Since then our group have published six studies that contained data from 169 swine showing that with prolonged cardiac arrest due to ventricular fibrillation, survival is the same with chest-compression-alone resuscitation as with ideal CPR, when chest compressions are interrupted for only 4 s for respiration. The prevalence of bystander-initiated CPR varies but averages somewhere between 20 and 30%. Surveys indicate that prevalence could be markedly increased if bystander chest-compression-alone CPR was advocated for individuals with witnessed unexpected sudden collapse. Chest-compression-alone ‘CPR’ has been advocated since November 2003 in Tucson, Arizona. There are data in humans to support chest compression alone for bystander resuscitation. The investigators from the Kanto area of Japan performed a survey of survivors in a study designated SOS-KANTO . They reported on 9592 out-of-hospital arrests. Of these, 4241 were witnessed. No bystander CPR was provided by 2917 cases (69%) and bystander CPR was provided in 1324 cases (31%). The type of bystander CPR was documented in 1151 cases. Of these, 712 victims (62%) received chest compression plus mouth-to-mouth ventilation and 439 victims (38%) received chest compression alone. Neurologically normal survival at 30 days was greater in those with witnessed arrest with. A large Meta-analysis from 2010 has also shown superiority of CCR vs standard CPR. The technique is ideally taught with emphasis on a metronome-guided rate of 100 per min. Additionally, full chest recoil after each compression is specifically emphasized. This approach can be easily and efficiently taught.