Response to Letter Regarding Article “Effectiveness of Bystander-Initiated Cardiac-Only Resuscitation for Patients With Out-of-Hospital Cardiac Arrest”
We thank Drs Lederer and Wiedermann for their interest and comments on bystander-initiated cardiac-only resuscitation. Although cardiac-only resuscitation is not a novel concept, our large-scale population-based study and other recent investigations provide important clinical evidence that bystander-initiated cardiac-only resuscitation is at least as effective as bystander-initiated chest compressions plus rescue breathing.1 These new data in different settings with different systems indicate that these findings are robust and generalizable.
Reluctance for rescue breathing is not the only factor affecting the willingness of bystanders to initiate CPR. Nevertheless, a multitude of data indicates that rescue breathing is a major obstacle for the provision of bystander CPR.2 In addition, ample data demonstrate that simpler techniques, such as cardiac-only resuscitation, are easier to teach, remember, and perform.2 Although continuous chest compressions may cause rescuer fatigue and result in CPR deterioration over time, interruptions of chest compressions for rescue breaths is a more substantial problem for providing adequate circulation.3,4,5 Lederer and Wiedermann propose studying modified ratios of rescue breaths to compressions; however, providing any rescue breaths is an additional barrier to learning and performing CPR.
Finally, we agree with Lederer and Wiedermann on the need for bystander CPR advocacy and public awareness campaigns. We also believe that recommendations are not enough; programs must be implemented and outcomes must be measured to determine whether the programs save lives. In Osaka, we have started to teach people the simplified CPR technique of cardiac-only resuscitation, and we are evaluating whether this new program will increase the frequency of bystander-initiated CPR and will result in higher rates of long-term survival.