CPR can save a life. But, it has to be effective. The recent move to compressions only CPR has simplified matters for the lay provider, but are we actually seeing improved outcomes. Essentially, is asking someone to just “push hard and fast” on the chest of a patient with out of hospital cardiac arrest (OHCA) sufficient? I just read an interesting study out of Japan that investigated the outcomes of children (yes, a large resuscitation study on children) with OHCA, and compared no CPR, compressions only CPR and dispatcher-assisted CPR. In Japan, EMS providers cannot terminate resuscitation efforts in the field. Dispatch protocols also vary by region, but in general it is offered to bystanders who call EMS services for help. The dispatcher “offers CPR instruction for chest compression plus rescue breathing (conventional) or chest‐compression‐only CPR, depending on the skill or knowledge of the bystander.”
The main outcome of this study was “favorable” neurologic status at one month status post OHCA. As you’d expect the scene providers did better when they had assistance. Dispatcher CPR instruction was offered to almost 54% of patients. This dispatcher assistance significantly increased the odds of bystander CPR being provided in the first place – adjusted odds ratio (aOR), 7.51; 95% confidence interval I don’t think that you can conclude that conventional CPR (rescue breaths plus chest compressions) is necessarily better. This study was retrospective, and it did not take into account the skill level and prior experience and training of the providers. However, I have always been taught – and have seen personally – that many pediatric arrests are asphyxial. A trained provider – especially with a helping hand – can provide effective CPR with rescue breaths. Reading this study has inspired me to discuss dispatcher assistance protocols with local EMS leaders in an effort to learn more. Perhaps it will do the same for you.
