March 19, 2007 – It is better to give continuous chest compressions to victims of sudden cardiac arrest (SCA) than to provide conventional cardiopulmonary resuscitation (CPR), according to a new study published in The Lancet. Researchers Ken Nagao, MD, and his colleagues from Surugadai Nihon University Hospital in Tokyo, reached this conclusion after evaluating 4,241 cases of SCA occurring among adult patients in the Kanto region of Japan during a recent 16-month period.
When researchers looked at the subgroup of patients whose arrests were witnessed by bystanders and who had a shockable heart rhythm when emergency responders arrived, they found that 22 percent of the 439 patients who received chest compressions only survived with good neurological function, compared with 10 percent of the 712 patients who received a combination of chest compressions and ventilations. They also concluded that any CPR was better than no CPR.
The reason chest compressions alone were effective, researchers suggest, is that there is sufficient oxygen in the body to last for a few minutes, and it is more important to focus on circulating blood to the brain.
The study is of “utmost importance,” wrote Gordon Ewy, MD, of the University of Arizona College of Medicine in Tucson, in an accompanying editorial, and “should lead to an interim revision of the guidelines for out-of-hospital cardiac arrest.” The American Heart Association’s most recent guidelines, published in 2005, did call for increasing the ratio of compressions to breaths from 15:2 to 30:2, however Ewy argues the change did not go far enough. His research team has advocated for years that bystanders use chest-compressions only, a technique he calls cardiocerebral resuscitation (CCR).
The AHA supports a focus on chest compressions, but is unlikely to make any interim changes in guidelines. “It is important to note that victims of cardiac arrest from non-cardiac causes, like near-drowning or electrocution, and almost all victims of pediatric cardiac arrest benefit from a combination of rescue breathing and chest compressions," according to an AHA statement.
To read The Lancet article and editorial (PDF Document), click here.
For more information on cardiocerebral resuscitation (PDF Document), click here.