Background


The role of rescue breathing in cardiopulmonary resuscitation (CPR) performed by a layperson is uncertain. We hypothesized that the dispatcher instructions to bystanders to provide chest compression alone would result in improved survival as compared with instructions to provide chest compression plus rescue breathing.

 

Methods


We conducted a multicenter, randomized trial of dispatcher instructions to bystanders for performing CPR. The patients were persons 18 years of age or older with out-of-hospital cardiac arrest for whom dispatchers initiated CPR instruction to bystanders. Patients were randomly assigned to receive chest compression alone or chest compression plus rescue breathing. The primary outcome was survival to hospital discharge. Secondary outcomes included a favorable neurologic outcome at discharge.

 

Results


Of the 1941 patients who met the inclusion criteria, 981 were randomly assigned to receive chest compression alone and 960 to receive chest compression plus rescue breathing. We observed no significant difference between the two groups in the proportion of patients who survived to hospital discharge (12.5% with chest compression alone and 11.0% with chest compression plus rescue breathing,  Prespecified subgroup analyses showed a trend toward a higher proportion of patients surviving to hospital discharge with chest compression alone as compared with chest compression plus rescue breathing for patients with a cardiac cause of arrest (

Conclusions


Dispatcher instruction consisting of chest compression alone did not increase the survival rate overall, although there was a trend toward better outcomes in key clinical subgroups. The results support a strategy for CPR performed by laypersons that emphasizes chest compression and minimizes the role of rescue breathing.

What Is Sudden Cardiac Arrest?

Sudden Cardiac Arrest (SCA) is unpredictable, often striking people who have had no previous symptoms. It can happen anytime, anywhere, to anyone.

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SCA is the leading cause of death in America, killing more than 330,000 people per year (1).


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SCA occurs when the electrical impulses that trigger the rhythmic beating of the heart are disrupted. An abnormal, chaotic, quivering heart rhythm known as ventricular fibrillation results. Ventricular fibrillation causes the heart’s contractions to become ineffective and the forward flow of oxygenated blood to the brain and lungs stops.


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During Sudden Cardiac Arrest, the patient will lose consciousness and stop breathing. If a normal rhythm is not restored with a few minutes, death will certainly occur.


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Bystanders who recognize a cardiac arrest, contact Emergency Medical Services (911), provide compression only CPR, and use an Automated External Defibrillator (AED) if one is available, can significantly increase the chance of the patient’s survival.

 

What about preventing and planning for SCA?


Because Sudden Cardiac Arrest can occur without warning, prevention can play a large role in survival. Be sure to have regular checkups, be screened for heart disease, and live a heart-healthy lifestyle:

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Don’t smoke.


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Eat a balanced, nutritious diet.


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Embrace physical activity.