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
Drowned children do not benefit from resuscitation beyond 30 minutes
Children who drown and suffer from cardiac arrest with hypothermia are significantly more likely to die or suffer severe brain damage if resuscitation continues for more than 30 minutes, finds a study published in The BMJ.
Simple blood test can predict risk of dementia
Scientists at Rigshopitalet, Herlev Hospital and the University of Copenhagen identify a new biomarker that can predict the risk of developing dementia by way of a simple blood test. In the long term, this could mean better prevention and thus at least postponement of the illness and at best evading the development all together.
Peptide shows promise in penetrating heart attack scar tissue to regenerate cardiac nerves
Case Western Reserve's chemical compound aimed at restoring spinal cord function may have an additional purpose: stopping potentially fatal arrhythmias after heart attack.
Hydrogen sulfide could help lower blood pressure
A gas that gives rotten eggs their distinctive odour could one day form the basis of new cardiovascular therapies.
New hope for understanding sudden cardiac arrest
New biosciences research at the University of Kent could point the way to greater understanding of the heart mutations that cause sudden cardiac arrest.
Distrust of Police Is Top Reason Latinos Don't Call 9-1-1 for Cardiac Arrest
Fear of police, language barriers, lack of knowledge of cardiac arrest symptoms and financial concerns prevent Latinos - particularly those of lower socioeconomic status - from seeking emergency medical help and performing cardiopulmonary resuscitation (CPR).
If you are having a severe allergic reaction, you need epinephrine first and fast
If you are one of the millions of Americans who experiences a severe allergic reaction to food, latex or an insect sting, you should know the first line of defense in combating the reaction is epinephrine.
Basic vs. advanced life support outcomes after out-of-hospital cardiac arrest
Patients who had cardiac arrest at home or elsewhere outside of a hospital had greater survival to hospital discharge and to 90 days beyond if they received basic life support (BLS) vs. advanced life support (ALS) from ambulance personnel, according to a report published online by JAMA Internal Medicine.
Pregnant women with congenital heart disease may have low complication risks during delivery
Pregnant women with congenital heart disease had very low risks of arrhythmias (irregular heart beat) or other heart-related complications during labor and delivery.
Lay bystanders in higher income pennsylvania counties more likely to perform CPR
Members of the public in counties with higher median household incomes are more likely to step into action to perform cardiopulmonary resuscitation, or CPR, when they witness someone have a cardiac arrest.
More Cardiac Arrest Current Events and Cardiac Arrest News Articles