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Kiss of death?

Kiss of death? Survival rates improve with chest compression-only first aid

The so-called kiss of life has been credited with saving countless lives. But a new study has found that survival rates for people suffering from cardiac arrest when not in a hospital environment are better if the patient receives chest-compression only cardiopulmonary resuscitation (CPR), compared to patients who received the conventional CPR or no CPR at all.

Until recently the standard first aid advice for bystanders in situations where someone is having a cardiac arrest is to apply the familiar chest compression and mouth-to-mouth resuscitation (artificial respiration) procedure in a controlled sequence.

But some critics of this approach claim that it is flawed for two reasons: First, the complexity of the process is likely to discourage passers-by from attempting it, and the need to stop the chest compressions to administer the artificial respiration causes more damage that good.

Study result

The study looked at how likely a patient is to survive to the point of being discharged from hospital after a cardiac arrest when no medical equipment is available.

Cardiac arrests are major health problem, and studies have shown that early intervention can increase survival rates. To improve the overall outcome levels the US state of Arizona in 2005 embarked on a statewide study.

As part of the study the state also launched an education program to promote awareness of the possible benefits of chest compression only CPR (COCPR), on the basis that it is easier to learn, remember and administer.

The study looked at over 4,000 cases of adult cardiac arrest. Of these 2,900 received CPR from bystanders, 666 received conventional CPR and 849 received the newer COCPR.

The researchers found that rates of survival to hospital discharge were 5.2 percent for the no bystander CPR group, 7.8 percent for conventional CPR, and 13.3 percent for COCPR.

Additionally the annual rate for lay rescuers providing any type of bystander CPR increased significantly over time, from 28.2 percent in 2005 to 39.9 percent in 2009.

Explanation for results

The authors of the study suggest that there are multiple reasons COCPR may have advantages over conventional CPR techniques, including the rapid deterioration of forward blood flow that occurs during even brief disruptions of chest compressions, the long ramp-up time to return to adequate blood flow after resuming chest compressions, the complexity of conventional CPR, the significant time required to perform the breaths, and the critical importance of cerebral and coronary circulation during arrest.

The study is published in the October edition of JAMA.

This article was published on Wed 6 October 2010

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