Members of the public who perform emergency CPR should carry out only chest compression rather than mouth-to-mouth, experts say today.
Researchers claim that CPR – cardiopulmonary resuscitation – produces better results when it involves chest compression only, rather than the standard protocol of chest compression and mouth-to-mouth ventilation.
The findings were welcomed by British campaigners – who said it would simplify the task of bystanders, seeking to save the lives of heart attack victims.
Authors Dr Peter Nagele, of Washington University School of Medicine, St Louis, Missouri, USA, and Drs Michael Hüpfl and Harald Selig, of the Medical University of Vienna, reviewed existing evidence regarding chest-compression-only CPR and compared the findings with standard CPR in a meta-analysis.
Writing online at The Lancet, they say continuous, uninterrupted chest compressions are vital for successful CPR.
"By avoidance of rescue ventilations (mouth-to-mouth) during CPR, which are often fairly time-consuming for lay bystanders, a continuous uninterrupted coronary perfusion pressure is maintained, which increases the probability of a successful outcome,” they say.
The analysis included three trials in which more than 3,000 patients were randomly allocated to receive one of the two CPR techniques, according to the instructions given out by a member of the emergency services.
The results showed that chest-compression-only CPR improved the chances of survival compared with standard CPR, with 14 per cent compared with 12 per cent. However, none of the three trials showed statistically significant differences in the two techniques, the authors admit.
"Because survival rates after out-of-hospital cardiac arrest are low and large treatment effects are unlikely, very large sample sizes are needed to show a significant survival benefit,” the authors write.
"Our findings support the idea that emergency medical services dispatch should instruct bystanders to focus on chest-compression-only CPR in adults with out-of-hospital cardiac arrest."
Commenting on the report, Dr Jerry Nolan, of the Royal United Hospital NHS Trust, Bath, England, and Dr Jasmeet Soar, Southmead Hospital, North Bristol NHS Trust, Bristol, England, said compression-only CPR has an important role, especially for those who are untrained, who have only a minimum time for training, or who are unwilling or unable to provide rescue breathing.
“A bystander who starts CPR will not know how long the emergency medical services will take to arrive, and will not understand the difference between asphyxial and primary cardiac arrest,” they write. “Therefore, ideally, lay people should continue to be trained in standard CPR. But any CPR is better than no CPR.”
Claire O’Neill, who is leading a community resuscitation programme for the British Heart Foundation, said: "For someone who is untrained in cardiopulmonary resuscitation, doing both chest compressions and rescue breaths really well can be difficult, and they may be unwilling to do mouth-to-mouth.
"We also know that uninterrupted chest compressions are very important for increasing the chance of survival. So being directed to focus solely on chest compressions could make people more willing to attempt resuscitation, which could ultimately save lives."
The Lancet October 15 2010
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