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Table 1 Primary and secondary cited OHCA studies in AHA and ERC 2010 guidelines related to adult survival with compression-only CPR

From: Push hard, push fast, if you’re downtown: a citation review of urban-centrism in American and European basic life support guidelines

Citation (year) [citation no.] Source Study description Outcome measure Location Mean EMS response time (minutes) or stratification Role of dispatcher assistance Main finding Bystander CPR by type, rate of survival (%)
None Comp’n Only CPR Conventional CPR
Bohm et al. (2007)[18] AHA, ERC, SRS(S1) SRS(S2) Retrospective cohort study of all patients with OHCA from any cause who received bystander CPR. 1-month survival Sweden Not reported. Results stratified into two response time groups <8 vs >8 minutes No dispatcher support. No significant difference in outcome between standard CPR and compression-only CPR cohorts. No significant difference identified when cohorts stratified by EMS response time (< 8 min vs. > 8 min). - 591/8209 77/1145
(7) (7)
Hallstrom (2000)[26] SRS(S1) SRS(S2) RCT of dispatcher instructions for all adult cardiac arrests (toxic causes excluded) Survival to hospital discharge King County, Washington USA, (Seattle) 4 Dispatcher randomly assigned to instruct willing bystanders in either compression-only or conventional CPR. Outcomes with compression alone are similar to outcomes with compressions and mouth-to-mouth ventilation. - 32/240 29/278
(15) (10)
Iwami et al. (2007)[19] AHA, ERC, SRS(S1) SRS(S2) Prospective population study of all consecutive witnessed adult OHCA patients of presumed cardiac origin. Neuro. favourable 1-year survival Osaka, Japan Results stratified by EMS response time <15 vs. >15 minutes Not addressed. Compression-only CPR yielded better outcomes over conventional CPR. For arrests lasting >15 minutes until EMS arrival, neurologically favourable 1-year survival was greater in the conventional CPR group (2.2% vs 0.3%, p < 0.05). 70/2817 19/441 25/617
(3) (4) (4)
Ong et al. (2008)[17] AHA, SRS(S2) Prospective cohort study of all OHCA patients attended to by EMS providers. Survival to hospital discharge Singapore 10.2 During the study period, no dispatcher CPR instructions were given. No significant difference in outcome between conventional CPR vs. compression-only CPR groups. 9/1695 4/154 8/287
(0.5) (2.6) (2.8)
Rea et al. (2010)[15] ERC Multicentre RCT of compression-only vs. conventional CPR instruction provided by EMS dispatchers in suspected witnessed OHCA. Survival to hospital discharge. King Country and Thurston County, Washington USA and London Ambulance Service, UK. 6.5 (no significant difference between study arms) Central to study design. All participants received CPR with prompts from EMS dispatcher. No difference in proportion of patients surviving to hospital discharge by randomization status. - 122/978 (12.5) 105/956 (11.0)
SOS-KANTO Study Group (2007)[20] AHA, ERC, SRS(S1) SRS(S2) Prospective cohort study of all witnessed adult cardia arrests of cardiac and noncardiac causes. Neuro. Favourable 1-month survival Kanto region, Japan Results stratified by time from EMS call to first AED analysis ≤10 vs >10 minutes Dispatcher assistance focused on chest compressions. Compression-only resuscitation results in better outcome than conventional CPR. No evidence for benefit from mouth-to-mouth ventilation in any subgroup. 63/2917 27/439 30/712
(2) (6) (4)
Svensson et al. (2010)[16] ERC RCT of compression-only vs. conventional CPR instruction by EMS dispatchers in suspected witnessed OHCA. 30-day survival Sweden with “inclusion of large rural areas” Randomization stratified by EMS response time ≤ 5 min, 6–8 min, 9–15 min and >15 min Central to study design. All participants received CPR with prompts from EMS dispatcher. No difference with respect to survival at 30 days based on the type of CPR instruction given. Effect consistent across EMS response time strata. - 54/620 (8.7) 46/656 (7.0)
Van Hoeyweghen et al. (1993)[25] Same data set as Bossaert et al. (1989) [24] SRS(B) SRS(S1) SRS(S2) Retrospective observational study of all cardiac arrests from all causes, with good quality compression-only or conventional CPR or no CPR. 14-day survival Belgium 4.3 min in no bystander CPR group, 2.9 minutes in the bystander CPR group Not addressed. No statistically significant difference in outcomes in patients who received compression-only CPR vs. conventional CPR. 123/2055 17/116 71/443
(6) (15) (16)
Waalewijn et al. (2001)[27] SRS(S1) SRS(S2) Prospective observational study of all bystander-witnessed adult cardiac arrests with EMS resuscitation Survival to hospital discharge Amsterdam, The Netherlands Mean not provided. OR of survival 0.83 per minute delay in time to EMS arrival (95% CI 0.76-0.90) Dispatchers encouraged initiation of ‘basic CPR’, with ventilations. Similar outcome in cases where chest compression was or was not accompanied by ventilation efforts. 26/429 6/41 61/437
(6) (15) (14)
  1. AED, Automated External Defibrillator; AHA, American Heart Association; CI, confidence interval; CPR, cardiopulmonary resuscitation; EMS, emergency medical services; ERC, European Resuscitation Council; RCT, Randomized Controlled Trial; SRC(B), Secondary Review Citation (Becker) [21]; SRC(S1), Secondary Review Citation (Sayre 2008) [22]; SRC(S2), Secondary Review Citation (Sayre 2010) [23]; UK: United Kingdom; USA, United States of America.