Chest-compression only CPR training improves survival after cardiac arrest

Japanese patients who received chest-compression only CPR after an out-of-hospital cardiac arrest had an increase in survival with a favorable neurologic outcome, according to a nationwide observational study.

The incidence of survival with favorable neurologic outcome attributed to chest-compression only CPR increased from 0.6 per 10 million population in 2005 to 28.3 per 10 million population in 2012.

The increase coincided with the release of Japanese CPR guidelines in 2010 that recommended training in chest-compression only CPR for lay-rescuers.

Taku Iwami, MD, MPH, PhD, of Kyoto University Health Service in Kyoto, Japan, and colleagues published their findings online in Circulation on June 5.

The researchers evaluated a registry set up in 2005 by Japan’s Fire and Disaster Management Agency. They included patients who had an out-of-hospital cardiac arrest, were resuscitated by bystanders or emergency medical service (EMS) personnel and transported to medical institutions from Jan. 1, 2005 through Dec. 31, 2012.

During the eight years, there were 816,385 out-of-hospital cardiac arrests that met the eligibility criteria. Of the patients, 30.6 percent received chest-compression only CPR, 12.3 percent received conventional CPR and 57.1 percent received no CPR. In 2012, 47.3 percent of patients received bystander-initiated CPR, up from 34.6 percent in 2005. Meanwhile, the proportion of patients receiving chest-compression only CPR increased from 17.4 percent in 2005 to 39.3 percent in 2012.

EMS providers followed survivors for up to a month following the cardiac arrest. After a month, patients were interviewed and assessed for neurological outcomes using the cerebral performance category scale, which ranged from category 1 (good cerebral performance) to category 5 (death).

Iwami et al wrote that the effectiveness of chest-compression only CPR depended on the proportion of bystander CPR, the EMR system and hospital care quality and the development of a public-access defibrillation (PAD) program. Japan has well-trained EMR personnel and a top PAD program, but other countries without those advantages may not benefit as much from chest-compression only CPR, according to the researchers.