A preliminary
study of dispatcher-instructed bystander cardiopulmonary resuscitation
and a subsequent study of CPR in swine suggested that chest
compression alone may be as effective as compression plus
mouth-to-mouth ventilation. Prompted by these findings, investigators
tested the hypothesis that dispatcher-instructed bystander CPR by
chest compression alone would increase survival to hospital
discharge by at least 3.5 percent over compression plus
mouth-to-mouth.
Callers to an
urban emergency medical system were assigned randomly to receive
instruction in CPR by 1 of the 2 methods. Of 1296 calls, 776 were
excluded on the basis of predetermined criteria and the remaining
520 were randomized. A total of 64 patients (12.3 percent) survived
to hospital discharge, 14.6 percent of the chest-compression-only
group and 10.4 percent of the compression-plus-mouth-to-mouth group;
the difference was not statistically significant (P=0.18).
When these data were combined with results from a preliminary (and
identically designed) study, the lack of a statistically significant
difference between groups was preserved. Age, location of arrest,
and whether arrest was witnessed were predictors of survival to
discharge.
Comment: The authors conclude that there is no difference in
outcome between the 2 methods and that chest compression alone may
be sufficient for bystander CPR to be effective. This is probably
true, but failure to demonstrate a difference in a study such as
this doesn't necessarily mean that there is no difference.
Nevertheless, given the prestige of the New England Journal of
Medicine, no one will blame a bystander for omitting mouth-to-mouth
resuscitation from CPR.
— JS Bohan
Published in Journal Watch Emergency Medicine July 5, 2000
Source
Hallstrom A et al. Cardiopulmonary
resuscitation by chest compression alone or with mouth-to-mouth ventilation. N
Engl J Med 2000 May 25 342 1546-1553.