CPR只要壓胸就好!!

2007年有一篇non-randomized study說compression only CPR預後比較好，嚇死人了
結果2010年NEJM在美國兩個地方及英國倫敦三個地方募了1941個病人
排除掉trauma, drowning, 及asphyxiation的病人

結果chest compression vs. conventional CPR , survival rate都是11-15%無差，而在純cardiac causes of CPR的人中，neurological recovery來說compression only較佳(18.9%
vs 13.5%)

Bystander Cardiopulmonary Resuscitation: Chest Compression Alone or with Rescue Breathing?

A randomized trial shows no difference in adult patient outcomes with the two approaches.

A previous nonrandomized study showed improved outcomes from adult cardiac arrest with compression-only cardiopulmonary resuscitation (CPR) compared with conventional CPR (JW Emerg Med Mar 30 2007). Now, researchers compared outcomes with the two methods in a randomized study of consecutive 911 calls for cardiac arrest to three emergency medical services systems (2 in Washington State and 1 in London). After determining patient eligibility (unconscious, not breathing normally, bystander CPR not already under way), dispatchers randomly assigned patients to chest compression only or conventional CPR and provided instructions to bystanders about how to perform the assigned method. Patients who were younger than 18 years or who had arrest because of trauma, drowning, or asphyxiation were excluded. During the study period, which ranged from 3 to 5 years at the three sites, 1941 patients were enrolled.

No significant differences were noted between the chest-compression–only and conventional CPR groups in rates of survival to hospital discharge — the primary outcome — (12.5% and 11.0%) or favorable neurological status at discharge (14.4% and 11.5%). Prespecified subgroup analysis of patients with cardiac causes of arrest showed no significant difference in overall survival rate between the chest-compression–only and conventional CPR groups (15.5% and 12.3%) but a significant improvement in the rate of neurologically favorable survival in the chest-compression–only CPR group (18.9% vs. 13.5%).

Comment: The finding that chest compression alone is not inferior to chest compression plus rescue breathing is important, because doing away with breathing might increase the prevalence of bystander CPR. This simpler technique should be adopted for both bystanders and basic-level prehospital providers. The authors note that the finding from the subgroup analysis should prompt research in "targeted application of type-specific CPR."

— J. Stephen Bohan, MD, MS, FACP, FACEP

Published in Journal Watch Emergency Medicine July 28, 2010
Citation(s):

Rea TD et al. CPR with chest compression alone or with rescue breathing. N Engl J Med 2010 Jul 29; 363:423.

https://docs.google.com/fileview?id=0B278nGJMQBk7MThiMzk2ZmUtY2I2OS00ZTk4LWE2MTQtZjdhZDQ1Y2JiYmM4&hl=zh_TW

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