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.