A recent review in Circulation comes to the conclusion that chest compressions alone may be slightly more effective than the traditional chest compressions plus rescue breathing in bystander resuscitation of cardiopulmonary arrest. This is yet more evidence that the recommendations for hands only CPR are not just OK, they may be better. In this study two groups are compared. In one group the emergency dispatcher called (i.e. the person on the phone at 911) gave instruction to provide chest compression only. In the other cohort callers were instructed to do chest compression plus rescue breathing. There were about 1250 patients in each group and the chest compression only group had slightly higher long term survival rates.
This conclusion shows to me once again that data trumps intuition almost all of the time. Intuitively it seems like using a combination of rescue breathing plus chest compressions would be more effective than chest compressions alone. The reason for better results in the chest compression only group could be any of several possibilities. Maybe when bystanders were instructed to do chest compression alone they were less intimidated and actually did the chest compressions, whereas when asked to do both chest compressions and rescue breathing they did neither. Maybe trying to do both led to less effective chest compressions. Maybe there is something about doing rescue breathing that leads to worse outcomes. Maybe some combination of these factors or something I have not considered is the explanation. It is likely we will not understand this better unless the two are compared in more controlled settings, like the emergency department or intensive care unit. Neither is likely to happen, and the comparison is not really relevant as there is a world of difference in expert airways management in the ER vs. mouth-to-mouth rescue breathing on the sidewalk.
Keep in mind that about 90% of the time when cardiac arrest occurs outside the hospital setting the victim dies. The survival rates for the two groups were about 10% more likely to survive, but actual improvement was about 1%, i.e. a 10% improvement in an approximately 10% survival rate.
What is the big lesson here? First don’t feel that you are copping out or not doing your best by doing chest compressions only. It is at least as good, maybe even better that combination chest compression and rescue breathing. Secondly the most important thing you can do for a cardiopulmonary arrest patient is to get them access to advanced resuscitation, i.e. defibrillation. Call 911 first and if possible find an AED (Automated external defibrillator) and use it. Also don’t feel like you failed if a victim you try to resuscitate does not make it. 90% of the time sudden cardiac arrest outside the hospital results in death. Last, and maybe most important, do what you can to avoid sudden cardiac arrhythmia. Quit smoking, don’t do drugs like cocaine or methamphetamine, lose weight, exercise regularly, if you are at risk for arrhythmia get medical help and comply with your physician’s advice. The best way to survive cardiac arrest is to avoid having the arrest in the first place.
Watch the American Heart Association video on Hands Only CPR to be sure you remember how to respond: