CardioExchange Archive

A recent randomized, controlled study in the NEJM showed that patients with out-of-hospital cardiac arrest who received compression-only CPR or traditional CPR had similar 30-day survival rates. CardioExchange asks Dr. Mark Link, a cardiac electrophysiologist and member of the American Heart Association Advanced Cardiac Life Support Committee, to answer our questions about compression-only vs. traditional CPR.

Are we at a point where we can tell people that ventilation is not necessary during CPR?

The current AHA guidelines state that it is okay for bystanders to give compression-only CPR. In fact, compression-only CPR is recommended to improve the rates of bystander CPR. What is really at issue is whether all individuals, including health care providers, should give compression-only CPR to cardiac-arrest victims. The latest randomized data on compression-only CPR demonstrate equivalent survival of cardiac-arrest victims given standard CPR or compression-only CPR. In some animal studies, compression-only CPR is associated with an improved survival. Even if compression-only CPR and compression-with-ventilation CPR are equivalent in resuscitating victims, there would be a strong argument to recommend what is palatable to bystanders; I don’t think there is any doubt that compression-only CPR would be the most palatable.

However, it is likely that at some stage of CPR — say at 5 to 7 minutes — the oxygen reserves of the blood will be exhausted and ventilation is important. It is at about this time that emergency crews would arrive, so they will still need to be trained to ventilate a cardiac-arrest patient.

What do you think we should tell the public?

I think that we should stress that any CPR is better than no CPR, and that compression-only CPR and compression-with-ventilation CPR are quite similar in efficacy. Thus, CPR should be initiated with compression, and if someone is willing to perform ventilation, then by all means proceed with ventilation in addition to compression.

What should we do on the wards as initial treatment until the defibrillator arrives?

In an in-house cardiac arrest, simple compressions should be initiated while the defibrillator is being readied. Ventilation — and especially intubation — should be delayed until defibrillation is performed.

Outside the hospital, are there any situations or circumstances where ventilation should still be considered a priority?

Ventilation is of primary importance in respiratory arrests. These include asthma, aspiration, and drowning. In most witness cases of arrest, it is not difficult clinically to tell the difference between a cardiac and a respiratory arrest. However, in nonwitnessed arrest it is much more difficult to ascertain the cause.