New Studies Confirm Chest Compressions Alone are Life-saving for Cardiac ArrestDecember 26, 2007
Two large-scale studies published in the Dec. 18 issue of the American Heart Association's medical journal, Circulation, report that the chances of surviving cardiac arrest are no better - and may be worse - when bystanders perform mouth-to-mouth breathing than if they press on the chest without interruption.
In part because of the hesitance of bystanders to initiate CPR, survival rates following out-of-hospital cardiac arrest have remained dismal and virtually unchanged despite several changes of the CPR guidelines over the past four decades. In the two latest studies, research groups from Sweden and Japan compared survival rates of cardiac arrest victims after bystanders used either traditional CPR with mouth-to-mouth breathing or Chest-Compression-Only CPR.
Both studies found no statistically significant difference in survival rates. The Swedish study, led by Katarina Bohm, RN, of the South General Hospital in Stockholm, analyzed outcomes of nearly 10,000 cases, while a team led by Taku Iwami, MD, at Japan's National Cardiovascular Center in Suita, Japan, looked at the outcomes of 4,900 cases of witnessed out-of-hospital cardiac arrest. Robert Berg, MD, professor of pediatrics at the UA College of Medicine and a member of the Sarver Heart Center Resuscitation Research Group, co-authored the latter study.
"These independent findings confirm what our Resuscitation Research Group and others have found," says Gordon A. Ewy, MD, director of The University of Arizona Sarver Heart Center, where Continuous-Chest-Compression CPR without mouth-to-mouth breathing was pioneered. "To rescue someone who suddenly collapses for no apparent reason, mouth-to-mouth breathing makes no sense."
Shortly before the two latest observational studies were published, Dr. Ewy and his colleagues reported the results of a laboratory study suggesting that cardiac arrest patients face better odds of survival if they receive continuous chest compressions than if treated with standard CPR, in which chest compressions are interrupted by mouth-to-mouth breaths.
"Studies have shown over and over again that four out of five bystanders would not do CPR because of the mouth-to-mouth part," says Dr. Ewy, who has commented on the two new studies in an invited editorial published in the same issue of Circulation. "If people don't have to worry about the so-called rescue breathing, they are much more likely to actually do CPR on someone who needs it. This fact alone is the key to saving more lives. If someone calls the emergency medical services and does nothing, the individual has almost no chance of surviving."
Earlier this year, the then-largest study comparing survival rates of cardiac arrest victims in the light of the kind of rescue efforts performed by bystanders concluded that chances of leaving the hospital alive were actually higher for patients who received Continuous-Chest-Compression CPR (Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study; Lancet 2007:369:920-926).
Dr. Ewy says, "It is interesting that Continuous-Chest-Compression CPR, a technique that has not been advocated or taught and is most often performed by individuals not trained in CPR, results in similar survival as the guidelines-advocated approach, on which millions of hours and millions of dollars have been spent teaching and advocating."
He adds that mouth-to-mouth ventilation is disadvantageous in cases of sudden cardiac arrest for three primary reasons. "A person whose heart suddenly stops, for example because of a heart attack, was breathing normally only seconds earlier so there is plenty of oxygen in the blood. The important thing is to move the blood around, and this is only possible by uninterrupted chest compressions. During CPR, blood flow to the brain and the heart is so marginal that stopping for anything, including ventilation, is harmful to the brain. In addition, research has shown that forced ventilation, including mouth-to-mouth breathing, increases the pressure in the patient's chest, which in turn inhibits blood flow back to the heart."
University of Arizona Health Sciences Center
Related Cardiac Arrest Current Events and Cardiac Arrest News Articles
Opioid users breathe easier with novel drug to treat respiratory depression
People taking prescription opioids to treat moderate to severe pain may be able to breathe a little easier, literally.
Survival increases with clinical team debriefing after in-hospital cardiac arrest
A new study found that staff members who joined structured team debriefings after emergency care for children suffering in-hospital cardiac arrests improved their CPR performance and substantially increased the rates of patients surviving with favorable neurological outcomes.
2014 ESC/ESA Guidelines on non-cardiac surgery: Cardiovascular assessment and management
The publication of the new joint ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management introduces a number of recommendations in the field.
New EMS System in Arizona Dramatically Improves Survival from Cardiac Arrest
A new system that sent patients to designated cardiac receiving centers dramatically increased the survival rate of victims of sudden cardiac arrest in Arizona, according to a study published online yesterday in Annals of Emergency Medicine (Statewide Regionalization of Postarrest Care for Out-of-Hospital Cardiac Arrest: Association With Survival and Neurologic Outcome).
Improving bystander resuscitation following cardiac arrest outside hospital could save 100,000 lives across Europe each year
A session at this year's Euroanaesthesia meeting will discuss how improving the skills of members of the public, including schoolchildren, in resuscitation following cardiac arrest could save up to 100,000 lives per year.
Potential cure for captive amphibians with chytrid fungus
Researchers at Vanderbilt University have identified an alternative to a sometimes toxic therapy that protects frogs in zoos from a deadly fungal infection that has been destroying the amphibian populations worldwide.
Population screening for SCD in young people: Feasible with basic screening program
Despite fears over cost, the wide-scale screening of young people to detect risk of sudden cardiac death (SCD) is feasible and cost effective, according to a study presented at EuroPRevent 2014.
Adrenaline does little to increase patient's survival after cardiac arrest
Giving patients adrenaline after they suffer a cardiac arrest outside of a hospital does not increase their prospects of surviving long-term, according to new research conducted at St. Michael's Hospital.
Lifespan researcher develops first blood test to predict risk of sudden cardiac death
A researcher at the Cardiovascular Institute (CVI) at Rhode Island, The Miriam and Newport hospitals has found that a simple blood test can predict a person's risk for sudden cardiac death, enabling physicians to more quickly and accurately assess a patient's need for an implantable cardiac defibrillator (ICD).
Clonidine doesn't reduce deaths or heart attack after non-cardiac surgery
Clonidine - a drug that reduces blood pressure and heart rate - increased rates of clinically concerning hypotension and non-fatal cardiac arrest after noncardiac surgery, according to the POISE-2 trial presented at the American College of Cardiology's 63rd Annual Scientific Session.
More Cardiac Arrest Current Events and Cardiac Arrest News Articles