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