A prospective multi-centre observational study in Japan 1 included 4068 adults who had out-of-hospital cardiac arrest witnessed by bystanders. Paramedics assessed the technique of bystander resuscitation. 11% received cardiac-only resuscitation by bystanders, 18% received conventional resuscitation (CPR), and 72% received no bystander resuscitation. Cardiac-only resuscitation resulted in a higher proportion of favourable neurological outcomes than conventional CPR in patients with apnoea (6.2% vs 3.1%, p=0.0195), and in patients with shockable rhythm (19.4% vs 11.2%, p=0.041) and in patients whose resuscitation started within 4 min of arrest (10.1% vs 5.1%, p=0.0221). The OR for a favourable neurological outcome after cardiac-only resuscitation was 2.2 (95% CI 1.2 to 4.2). There was no benefit from the addition of mouth-to-mouth ventilation in any subgroup.
In an RCT 2 telephone advice on cardiac-only resuscitation was given to laymen for 241 patients and advice on conventional CPR was given for 279 patients. 14.6% of those who received cardiac-only resuscitation were discharged from hospital compared to 10.4% of those who received conventional CPR (difference non-significant).
Comment: The quality of evidence is upgraded by strong association. The results are not applicable to patients who have primary respiratory arrest (e.g. drowning or suffocation)
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