Study compares new cardiopulmonary resuscitation with standard CPR in cardiac arrest

Continuous chest compression, touted as the new way to perform cardiopulmonary resuscitation, was not an improvement over standard CPR, according to findings published in the New England Journal of Medicine today. The University of Alabama at Birmingham was one of eight United States and Canadian universities involved in the study, the largest such study of out-of-hospital cardiac arrest ever conducted.

The study looked at more than 23,000 adults with out-of-hospital cardiac arrest, for whom EMS crews responded. Those patients were randomized in the eight participating communities to either standard CPR or continuous chest compression. Standard CPR, known as 30:2, is 30 chest compressions with a pause for two ventilations, or breaths. CCC CPR is uninterrupted chest compressions with one ventilation every 10 compressions without a pause.

"We did not see any significant difference in neurologically intact survival to hospital discharge between patients receiving standard 30:2 CPR compared to those receiving CCC," said Henry Wang, M.D., professor in the UAB Department of Emergency Medicine and a study co-author. "The neurologically intact survival rate for patients receiving 30:2 CPR was 7.7 percent, against 7 percent for those receiving CCC."

The neurologically intact standard means that, upon discharge from the hospital, a patient has no significant cognitive deficit and can return to near-normal function.

"There have been some smaller-scale studies that suggest CCC was as effective or perhaps more effective than 30:2; but until now, that had never been tested in a full-scale, randomized clinical trial," Wang said. "The current results indicate that 30:2 and CCC are equally effective. Further evaluation of the role of ventilation in CPR is warranted."

Wang says that, over the past 10 years, CCC has been suggested as an easier and safer way for an individual to perform CPR.

"In the absence of differences in patient outcomes between the two CPR strategies, the study's conclusion is that EMS practitioners and their medical directors should decide on an individual basis if they will perform 30:2 or continuous chest compressions," said Shannon Stephens, an instructor in the Department of Emergency Medicine and a study co-author.