Cardiopulmonary Resuscitation

Despite extensive training of citizens in cardiopulmonary resuscitation (CPR), bystanders do not perform CPR in almost half of witnessed cardiac arrests. Instructions in chest compression plus mouth-to-mouth ventilation given by dispatchers over the telephone can require 2.4 minutes. In experimental studies, chest compression alone is associated with survival rates similar to those with chest compression plus mouth-to-mouth ventilation. The authors conducted a randomized study to compare CPR by chest compression alone with CPR by chest compression plus mouth-to-mouth ventilation.

The setting of the trial was an urban fire department-based, emergency-medical-care system with central dispatching. In a randomized manner, telephone dispatchers gave bystanders at the scene of an apparent cardiac arrest instructions in either chest compression alone or chest compression plus mouth-to-mouth ventilation. The primary end point was survival to hospital discharge.

The outcome after CPR with chest compression alone is similar to that after chest compression with mouth-to-mouth ventilation, and chest compression alone may be the preferred approach for bystanders inexperienced in CPR.
(Hallstrom A. N Eng J Med 2000; 342(21):1546-1553)

Comment: Note that this adjustment in CPR is for lay persons in a situation where an additional average delay of 2.4 minutes is involved before CPR is begun . It is unlikely that similar changes will be recommended for professionals well trained in CPR. - R. A.