A Cochrane review [Abstract] 1 included 4 studies with a total of 26742 subjects. Three studies assessed CPR provided by untrained bystanders (3737 participants) who administered CPR under telephone instruction from emergency services. One of these included out-of-hospital cardiac arrest (OHCA) patients who were equal to, or older than eight years of age, and the other two trials provided no information regarding the age of the participants. The fourth study compared approaches given by EMS professionals (23,711 participants); it included only adult OHCA. All studies were undertaken in rural areas.
When CPR was performed by bystanders T1, more people survived until discharge from hospital after chest compression alone than they did following interrupted chest compression with pauses at a fixed ratio for rescue breathing (15 compressions to 2 breaths). For this outcome the quality of the evidence was high. For survival to hospital admission and neurological outcomes at hospital discharge the evidence was moderate.
When CPR was performed by EMS professionals T2, survival to hospital discharge was slightly lower with continuous chest compressions (100/minute) plus asynchronous rescue breathing (10/minutes) CPR compared with interrupted chest compression plus rescue breathing. The quality of the evidence was moderate for the outcome of survival to hospital discharge. For survival to hospital admission and neurological outcomes at hospital discharge there was high-quality evidence.
| Outcome | Participants(studies) | Relative effect(95% CI) | Assumed risk - Interrupted chest compression plus ventilation | Corresponding risk - Continuous chest compression alone |
|---|---|---|---|---|
| Survival to hospital discharge | 3031(3) | RR 1.21 (1.01 to 1.46) | 116 per 1000 | 141 per 1000 (117 to 170) |
| Survival to hospital admission | 520(1) | RR 1.18(0.94 to 1.48) | 341 per 1000 | 402 per 1000 (320 to 504) |
| Neurological outcomes at hospital discharge (Measured as 'good' or 'moderate' with Cerebral Performance Category classification) | 1286(1) | RR 1.25(0.94 to 1.66) | 110 per 1000 | 138 per 1000 (103 to 183) |
| Outcome | Participants(studies) | Adjusted risk difference(95% CI) | Assumed risk - interrupted chest compression plus ventilation | Corresponding risk - Continuous chest compression with asynchronous rescue breathing |
|---|---|---|---|---|
| Survival to hospital discharge | 23,648(1) | ARD -0.7%(-1.5% to 0.1%) | 97 per 1000 | 90 per 1000 (82 to 98) |
| Survival to hospital admission | 23,711(1) | ARD -1.3%(-2.4% to -0.2%) | 259 per 1000 | 246 per 1000 (235 to 257) |
| Neurological outcomes at hospital discharge (Rankin score ≤ 3) | 23,555(1) | ARD -0.6%(-1.4% to 0.1%) | 77 per 1000 | 70 per 1000(56 to 78) |
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