The newenglan rcp

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n e w e ng l a n d j o u r na l


m e dic i n e

original article

CPR with Chest Compression Alone or with Rescue Breathing
Thomas D. Rea, M.D., Carol Fahrenbruch, M.S.P.H., Linda Culley, B.A., Rachael T. Donohoe, Ph.D., Cindy Hambly, E.M.T., Jennifer Innes, B.A., Megan Bloomingdale, E.M.T., Cleo Subido, Steven Romines, M.S.P.H., and Mickey S. Eisenberg, M.D., Ph.D.

A bs tr ac t

The role of rescue breathing in cardiopulmonary resuscitation (CPR) performed by a layperson is uncertain. We hypothesized that the dispatcher instructions to bystanders to provide chest compression alone would result in improved survival as compared with instructions to provide chest compression plus rescue breathing.

We conducted a multicenter, randomized trialof dispatcher instructions to bystanders for performing CPR. The patients were persons 18 years of age or older with out-ofhospital cardiac arrest for whom dispatchers initiated CPR instruction to bystanders. Patients were randomly assigned to receive chest compression alone or chest compression plus rescue breathing. The primary outcome was survival to hospital discharge. Secondary outcomesincluded a favorable neurologic outcome at discharge.

From the Emergency Medical Services Division of Public Health for Seattle and King County (T.D.R., C.F., L.C., M.B., C.S., M.S.E.) and the University of Washington (T.D.R., M.S.E.) — both in Seattle; the London Ambulance Service, London (R.T.D., J.I.); and Thurston County Medic One, Olympia, Washington (C.H., S.R.). Address reprintrequests to Dr. Rea at 401 5th Ave., Suite 1200, Seattle, WA 98104, or at N Engl J Med 2010;363:423-33.
Copyright © 2010 Massachusetts Medical Society.

Of the 1941 patients who met the inclusion criteria, 981 were randomly assigned to receive chest compression alone and 960 to receive chest compression plus rescue breathing. We observed no significant difference between thetwo groups in the proportion of patients who survived to hospital discharge (12.5% with chest compression alone and 11.0% with chest compression plus rescue breathing, P = 0.31) or in the proportion who survived with a favorable neurologic outcome in the two sites that assessed this secondary outcome (14.4% and 11.5%, respectively; P = 0.13). Prespecified subgroup analyses showed a trend toward ahigher proportion of patients surviving to hospital discharge with chest compression alone as compared with chest compression plus rescue breathing for patients with a cardiac cause of arrest (15.5% vs. 12.3%, P = 0.09) and for those with shockable rhythms (31.9% vs. 25.7%, P = 0.09).

Dispatcher instruction consisting of chest compression alone did not increase the survival rateoverall, although there was a trend toward better outcomes in key clinical subgroups. The results support a strategy for CPR performed by laypersons that emphasizes chest compression and minimizes the role of rescue breathing. (Funded in part by the Laerdal Foundation for Acute Medicine and the Medic One Foundation; number, NCT00219687.)

n engl j med 363;5

nejm.orgjuly 29, 2010

The New England Journal of Medicine as published by New England Journal of Medicine. Downloaded from by ENRIQUE NAVEIRA ABEIGON on July 29, 2010. For personal use only. No other uses without permission. Copyright © 2010 Massachusetts Medical Society. All rights reserved.


n e w e ng l a n d j o u r na l


m e dic i n e

ut-of-hospital cardiac arrestclaims hundreds of thousands of lives each year worldwide.1,2 Successful resuscitation is challenging but achievable, requiring an interdependent set of actions that consist of early arrest recognition, early cardiopulmonary resuscitation (CPR), early defibrillation, expert advanced life support, and timely postresuscitation care.3 Early initiation of CPR by a layperson can increase the...
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