Compression Only CPR

OVERVIEW

The Australian Resuscitation Council (ARC) guidelines for CPR currently recommend:

  • 2 ventilations followed by 30 chest compressions when performing CPR. Chest compressions should be delivered at a rate of 100 per minute ensuring adequate depth of compression and minimal interruption to compressions.
  • Where a rescuer is either untrained or unwilling to perform CPR they should deliver continuous uninterrupted chest compressions only at a rate of 100 per minute.
  • Untrained rescuers who seek basic life support instructions from Emergency Medical Services by telephone are advised to deliver continuous uninterrupted chest compressions only at a rate of 100 per minute.
  • Any attempt at resuscitation is better than no attempt.

ARGUMENTS FOR COMPRESSION-ONLY CPR

Physiological

  • in cardiac arrest the heart dilates -> CPR decompresses heart
  • ventilation -> decreased venous return
  • gasping provides adequate ventilation
  • presence of partial airway obstruction -> increased venous return

Logistic

  • reluctance to perform mouth-to-mouth by rescuers -> don’t even attempt compressions
  • interruption of compressions limit their effectiveness
  • easier to teach compression only CPR
  • will minimise time to hospital
  • useful in single rescuer situation

Studies

  • mostly observational or animal studies in support of compression-only CPR
  • 3 RCTs  show no difference in compression only vs ventilation + compressions (Hallstrom 2000, Svensson and Rea NEJM studies 2010); however Cabrini et al’s 2012 meta-analysis of all 3 suggests benefit.

ARGUMENTS AGAINST COMPRESSION-ONLY CPR

  • most studies observational
  • why change if there is no advantage
  • most of data was prior to 30:2 ratio
  • ventilation is important in many arrests (e.g. paediatrics, drowning)
  • ventilation may become more important if arrest lasts >4 minutes
  • not recommended in hospital arrests
  • continuous compression-only CPR may lead to earlier rescuer fatigue

SUMMARY

  • more evidence mounting in favour of compression only CPR
  • can be used if rescuer is untrained or reluctant to perform mouth-to-mouth

References and Links

  • Anantharaman V. Chest compression-only CPR or good quality 30:2 CPR. Singapore Med J. 2011 Aug;52(8):576-81. PMID: 21879215.
  • Bobrow BJ, Spaite DW, Berg RA, Stolz U, Sanders AB, Kern KB, Vadeboncoeur TF, Clark LL, Gallagher JV, Stapczynski JS, LoVecchio F, Mullins TJ, Humble WO, Ewy GA. Chest compression-only CPR by lay rescuers and survival from out-of-hospital cardiac arrest. JAMA. 2010 Oct 6;304(13):1447-54. PMID: 20924010.
  • Cabrini L, Biondi-Zoccai G, Landoni G, Greco M, Vinciguerra F, Greco T, Ruggeri L, Sayeg J, Zangrillo A. Bystander-initiated chest compression-only CPR is better than standard CPR in out-of-hospital cardiac arrest. HSR Proc Intensive Care Cardiovasc Anesth. 2010;2(4):279-85. PMC3484593.
  • Hallstrom A, Cobb L, Johnson E, Copass M. Cardiopulmonary resuscitation by chest compression alone or with mouth-to-mouth ventilation. N Engl J Med. 2000;342:1546–1553. [PubMed]
  • Rea T D, Fahrenbruch C, Culley L. et al. CPR with chest compression alone or with rescue breathing. N Engl J Med. 2010;636:423–433. [PubMed]
  • Svensson L, Bohm K, Castren M. et al. Compression-only CPR or standard CPR in out-of-hospital cardiac arrest. N Engl J Med. 2010;636:434–442. [PubMed]
  • Yao L, Wang P, Zhou L, Chen M, Liu Y, Wei X, Huang Z. Compression-only cardiopulmonary resuscitation vs standard cardiopulmonary resuscitation: an updated meta-analysis of observational studies. Am J Emerg Med. 2014 Feb 4. PMID: 24661781.
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Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health, a Clinical Adjunct Associate Professor at Monash University, and the Chair of the Australian and New Zealand Intensive Care Society (ANZICS) Education Committee. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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