Standard basic life support vs. continuous chest compressions only in out-of-hospital cardiac arrest

The importance of ventilations after cardiac arrest has been much debated recently and eliminating mouth-to-mouth ventilations for bystanders has been suggested as a means to increase bystander cardiopulmonary resuscitation (CPR). Standard basic life support (S-BLS) is not documented to be superior to continuous chest compressions (CCC).

Retrospective, observational study of all non-traumatic cardiac arrest patients older than 18 years between May 2003 and December 2006 treated by the community-run emergency medical service (EMS) in Oslo. Outcome for patients receiving S-BLS was compared with patients receiving CCC. All Utstein characteristics were registered for both patient groups as well as for patients not receiving any bystander CPR by reviewing Ambulance run sheets, Utstein forms and hospital records. Method of bystander CPR as well as dispatcher instruction was registered by first-arriving ambulance personnel.

Six-hundred ninety-five out of 809 cardiac arrests in our EMS were included in this study. Two-hundred eighty-one (40%) received S-CPR and 145 (21%) received CCC. There were no differences in outcome between the two patient groups, with 35 (13%) discharged with a favourable outcome for the S-BLS group and 15 (10%) in the CCC group (P=0.859). Similarly, there was no difference in survival subgroup analysis of patients presenting with initial ventricular fibrillation/ventricular tachycardia after witnessed arrest, with 32 (29%) and 10 (28%) patients discharged from hospital in the S-BLS and CCC groups, respectively (P=0.972).

Patients receiving CCC from bystanders did not have a worse outcome than patients receiving standard CPR, even with a tendency towards a higher distribution of known negative predictive features.