Monthly Archives: March 2012

Week 17 – Discussion Points

1. This is an observational study. Is this methodology appropriate for evaluating chest compression only vs conventional CPR?

2. What are the confounding factors that could have affected the results of this study? 

3. Are the outcome measures of this study appropriate?

4. Should guidelines for bystander CPR recommend conventional or chest compression only CPR? 

I look forward to tonight’s discussion which will start at 8.00pm GMT

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Week 17 – Chest compression only CPR vs conventional CPR

CPR is fairly simple thing to do, in basic life support we have been teaching for years that for every 30 chest compressions you do 2 rescue breaths. Chest compressions however are exhausting when done well, I was involved in a cardiac arrest fairly recently where another doctor and I provided 45 minutes of chest compressions and I have to admit I felt a bit of a physical wreck by the end.

A recent campaign was launched by the British Heart Foundation promoting “Hands-only CPR“. The video, featuring Vinnie Jones, is a must watch and explains how to do chest compression only CPR with “no kissing”, i.e. rescue breaths.  I have to say I was very impressed the video, it explains very well how to provide effective chest compressions and for that the BHF should be congratulated. I have witnessed the impact of this campaign first hand and anything that encourages the public to start chest compressions in an out of hospital cardiac arrest can only be a good thing. 

But what about the “no kissing” part of the video? Should we just be teaching chest compression only CPR or should we still be encouraging 30 chest compressions to 2 rescue breaths?

In 2011 an interesting study was published in the BMJ comparing outcomes with chest compression only CPR to conventional CPR in out of hospital cardiac arrests. This was a nationwide population based observational study carried out in Japan. From January 2005 to December 2007 all witnessed cardiac arrests were included in the study (when witnesed by lay people). In the chest compression only group there were 20,707 patients and in the conventional CPR group there were 19,328 patients. 

The study outcome measures were rates of one month survival and neurologically favourable one month survival (for a full description of this please see the paper).

The results - 

1. One month survival rates in patients with conventional CPR were significantly higher than in those with chest compression only CPR (adjusted odds ratio 1.97, 95% confidence interval 1.06 to 1.29)
2. Neurologically favourable one month survival was significantly high with conventional COR than with chest compression only CPR (adjusted odds ratio 1.17,  95% confidence interval 1.01 to 1.35)

The author’s conclusions:

In conclusion, we have shown that conventional CPR is associated with better outcomes than chest compression only CPR for one month survival and neurologically favourable one month survival. The benefit of conventional CPR is significantly greater in younger people with non-cardiac events and is also significantly greater with up to a 10 minute delay to the start of CPR after the event is witnessed for non-cardiac cases and all cases combined. These findings could be important for developing new guidelines for bystander CPR.

I look forward to discussing this paper on Sunday at 8.00pm GMT and, as always, discussion points will be posted beforehand

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Week 17 – Chest Compression Only CPR in Out of Hospital Cardiac Arrests

The paper for this Sunday’s #twitjc will be Outcomes of chest compression only CPR versus conventional CPR conducted by lay people in patients with out of hospital cardiopulmonary arrest witnessed by bystanders: nationwide population based observational study

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