Abstract P135: Effect of Bystander CPR With or Without Mouth-to-Mouth Ventilation on Outcome From Out-of-Hospital VF Cardiac Arrest
The survival of patients with out-of-hospital cardiac arrest (OHCA) is closely tied to the actions of the bystanders witnessing the collapse. Whether mouth-to-mouth ventilation during CPR is beneficial remains controversial. We compared the outcome of OHCA patients who received either chest compressions only CPR or traditional CPR administered by bystanders.
Methods: Data from a recently completed randomized trial (clinicaltrials.gov NCT00139542) comparing two different AED CPR protocols were used for this post-hoc analysis. All non-traumatic patients older than 18 years with OHCA requiring defibrillation were included. Available data included: age, gender, location of arrest, etiology, response time, defibrillation shock, presence of a bystander, bystander intervention. Bystander interventions were categorized between chest compressions only (CConly) and traditional CPR (tCPR). We evaluated the return of spontaneous circulation (ROSC), hospital admission, and one-year survival. Statistical analysis was performed by computing the univariate odds ratio (uOR) followed by the multivariate odds ratio (mOR) using a logistical regression model and the Cox model.
Results: From 09/2005 to 03/2007, 845 patients were enrolled. Among them, 86 (10.2%) received CConly and 71 (8.4%) received tCPR from bystanders. The baseline sociodemographic characteristics and intervention variables did not differ between these two groups. ROSC occurred more frequently after tCPR than CConly (uOR 1.96 [1.03–3.72]; mOR 2.41 [1.15–5.08], p=0.02). Hospital admission (uOR 2.05 [1.07–3.92], p=0.03; mOR 2.70 [1.29 –5.64], p=0.008) and one-year survival (adjusted relative risk of mortality 0.68 [0.48 – 0.98, p=0.041) were also greater following tCPR.
Discussion: Patients in VF who received traditional CPR from bystanders had a better outcome than those who received chest compressions without mouth-to-mouth ventilation. Further analysis is needed to determine if patients in asystole or other non-perfusing rhythms have the same benefit in outcome with tCPR. More research is needed to determine if bystander characteristics influence the CPR quality differently in each group.