October 14th, 2010
Meta-Analysis Lends More Support to Compression-Only CPR
Larry Husten, PHD
There’s new evidence supporting the movement away from traditional bystander CPR in favor of chest-compression-only CPR. In a paper appearing online in the Lancet, Michael Hüpfl, Harald F Selig, and Peter Nagele report the results of two separate meta-analyses. In the first meta-analysis, the investigators combined data from 3 randomized trials comparing compression-only CPR to standard CPR as directed by dispatcher instructions. The rate of survival to hospital discharge was 14% in the standard CPR group compared to 12% in the compression-only group (risk ratio 1.22, p=0.40).
However, in the second meta-analysis, the authors analyzed results from 7 observational cohort studies and found no difference between the two CPR techniques, with an 8% survival in each group. The authors noted that the second meta-analysis did not investigate dispatcher-assisted CPR. They concluded that their findings “support the idea that emergency medical services dispatch should instruct bystanders to focus on chest-compression-only CPR in adults with out-of- hospital cardiac arrest.”
In an accompanying comment, Jerry Nolan and Jasmeet Soar write that for adult cardiac arrest cases, the dispatcher should provide instructions on compression-only CPR: “the ‘kiss of life’ should be replaced by ‘Keep It Simple, Stupid’.”
One Response to “Meta-Analysis Lends More Support to Compression-Only CPR”
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But meta-analysis is always mathematically suspect. As a former physicist, I treat the results of meta-analysis as a hypothesis to be tested by future studies. The best analysis I have seen of the limitations of and problems with meta-analysis was given by Dr. George Thomas on 5/30/09 in his blog located at http://www.ghthomas.blogspot.com. I recall when Peto’s papers on meta-analysis were first published in the Lancet they were never convincing to me.