Abstract
Background
Current cardiopulmonary resuscitation (CPR) guidelines do not define the optimal type
of CPR (chest compression-only CPR [CCCPR] or conventional CPR with rescue breathing
[CCRB]) to be performed by bystanders when they witness someone collapse.
Methods
Using a nationwide database of 1.17 million patients who underwent out-of-hospital
cardiac arrest (OHCA) in Japan, we enrolled consecutive bystander-witnessed OHCAs
of medical origin with resuscitation attempts from January 2005 through December 2014.
Multivariable logistic regression analysis was used to assess the association between
the type of bystander CPR and the OHCA outcome after one-to-one propensity score matching
for CCCPR versus CCRB. The primary outcome measure was one-month survival with a favorable
neurological outcome, defined as a cerebral performance category of 1 or 2.
Results
Among 143,500 eligible patients with bystander-witnessed OHCAs receiving bystander-initiated
CPR, 71.4% received CCCPR and 28.6% received CCRB. In the univariate analysis, the
proportion of one-month survival cases with favorable neurological outcome was lower
in the CCCPR group than the CCRB group (5.6% [5749/102,487] vs. 6.5% [2682/41,013],
odds ratio [OR]; 0.85 [95% confidence interval {CI}; 0.81–0.89]). However, in the
multivariate analysis, the CCCPR group showed a more favorable neurological outcome
than the CCRB group (adjusted OR 1.12, 95% CI; 1.06–1.19). In the propensity-matched
cohort, the CCCPR group also showed a more favorable neurological outcome than the
CCRB group (7.2% [2894/40,096] vs. 6.5% [2610/40,096], adjusted OR 1.14, 95% CI; 1.09–1.22).
Conclusions
CCCPR is an acceptable resuscitation technique for lay-rescuers responding to bystander
witnessed OHCA of presumed medical origin.
Keywords
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Article info
Publication history
Published online: February 21, 2018
Accepted:
February 16,
2018
Received in revised form:
February 5,
2018
Received:
October 18,
2017
Footnotes
☆A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.10.1016/j.resuscitation.2018.02.017.
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
