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Bystanders inexperienced in CPR can use chest compression alone to revive victims of cardiac arrest

Many Americans have been trained in cardiopulmonary resuscitation (CPR) techniques. Yet half of the victims of out-of-hospital cardiac arrests in Seattle during the past few decades who were witnessed by bystanders did not receive bystander-initiated CPR.

The findings of a recent study should encourage more bystanders to step up to the plate. It shows that the outcomes of people who are administered CPR according to instructions given by the emergency medical dispatcher are the same after chest compression alone as after chest compression with mouth-to-mouth ventilation. Thus, bystanders inexperienced in CPR can use chest compression alone to help cardiac arrest victims, concludes the study, which was supported in part by the Agency for Healthcare Research and Quality (HS08197).

University of Washington researchers led by Alfred Hallstrom, Ph.D., randomly assigned 241 out-of-hospital cardiac arrest patients to receive chest compression alone and 279 to receive chest compression plus mouth-to-mouth ventilation. Emergency medical dispatchers gave bystanders instructions during 62 percent of episodes for chest compression plus mouth-to-mouth ventilation (taking about 2.4 minutes for instruction) and in 81 percent of episodes for chest compression alone, which required only 1 minute of instruction. Survival to hospital discharge was better among patients assigned to chest compression alone than those assigned to chest compression plus mouth-to-mouth ventilation, but the difference was not significant.

Only 20 dispatcher-instructed bystanders reported adverse effects to themselves, such as vomit from the patient or the sound of a rib cracking as they did the chest compressions. Callers receiving instructions in chest compression plus mouth-to-mouth ventilation were more likely to terminate them by hanging up or declaring that the instructions were too difficult than were callers receiving instructions in chest compression alone (7.2 vs. 2.9 percent).

See "Cardiopulmonary resuscitation by chest compression alone or with mouth-to-mouth ventilation," by Dr. Hallstrom, Leonard Cobb, M.D., Elise Johnson, B.A., and Michael Copass, M.D., in the May 25, 2000 New England Journal of Medicine 342(21), pp. 1546-1553.

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