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Cardiopulmonary resuscitation by bystanders with
chest compression only (SOS-KANTO): an observational study
SOS-KANTO study group
The Lancet 2007; 369:920-926
DOI:10.1016/S0140-6736(07)60451-6
Summary
Background
Mouth-to-mouth ventilation is a barrier to bystanders doing
cardiopulmonary resuscitation (CPR), but few clinical studies
have investigated the efficacy of bystander resuscitation
by chest compressions without mouth-to-mouth ventilation (cardiac-only
resuscitation).
Methods
We did a prospective, multicentre, observational study of
patients who had out-of-hospital cardiac arrest. On arrival
at the scene, paramedics assessed the technique of bystander
resuscitation. The primary endpoint was favourable neurological
outcome 30 days after cardiac arrest.
Findings
4068 adult patients who had out-of-hospital cardiac arrest
witnessed by bystanders were included; 439 (11%) received
cardiac-only resuscitation from bystanders, 712 (18%) conventional
CPR, and 2917 (72%) received no bystander CPR. Any resuscitation
attempt was associated with a higher proportion having favourable
neurological outcomes than no resuscitation (5·0% vs
2·2%, p<0·0001). Cardiac-only resuscitation
resulted in a higher proportion of patients with favourable
neurological outcomes than conventional CPR in patients with
apnoea (6·2% vs 3·1%; p=0·0195), with
shockable rhythm (19·4% vs 11·2%, p=0·041),
and with resuscitation that started within 4 min of arrest
(10·1% vs 5·1%, p=0·0221). However, there
was no evidence for any benefit from the addition of mouth-to-mouth
ventilation in any subgroup. The adjusted odds ratio for a
favourable neurological outcome after cardiac-only resuscitation
was 2·2 (95% CI 1·2–4·2) in patients
who received any resuscitation from bystanders.
Interpretation
Cardiac-only resuscitation by bystanders is the preferable
approach to resuscitation for adult patients with witnessed
out-of-hospital cardiac arrest, especially those with apnoea,
shockable rhythm, or short periods of untreated arrest.
The full study is available on The Lancet here.
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