CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

October 14th, 2010

Meta-Analysis Lends More Support to Compression-Only CPR

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’.”

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One Response to “Meta-Analysis Lends More Support to Compression-Only CPR”

  1. Robin Motz, M.D., Ph.D. says:
    October 14, 2010 at 9:20 pm

    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.