Compression Only or Traditional CPR-The Debate Rages On
If you were following the news last week you no doubt saw or read a story about a study in Japan that showed that permanent brain damage was less likely when victims of cardiac arrest were give compression only CPR (also called cardio-cerebral resuscitation or CCR) as opposed to those receiving traditional CPR (compressions and ventilations). This study was published in a recent issue of the medical journal The Lancet. In the study, researchers examined the post event neurological function of 4,068 patients who had been victims of witnessed cardiac arrest. The results showed healthy neurological function in 22% of those receiving compression only CPR compared with 10% of those receiving compressions along with ventilations.
This finding is in no way breaking news. In fact, the current study, and the media attention surrounding it are just a recent splash of lighter fluid on a decade old pile of glowing scientific embers. I haven’t had the time (nor interest to be honest) to find out when this debate began, however, I am aware that even as far back as October 1993 the magazine Circulation published studies on this topic. So, the debate rages on.
Which CPR method should be advocated? That is not a simple answer. In actuality, it depends on the person performing CPR, and the person it’s being performed on. Let me illustrate. If a fuel pump stops functioning properly in your car it needs to be replaced in order for a continued supply of fuel to be delivered to the the engine. However, if there is no fuel in the gas tank, replacing the pump in itself will be of no benefit. Likewise, when the human heart is out of normal rhythm its function must be replaced, in this case by manual contraction of the heart by means of chest compressions. Manual compression provided as quickly as possible will insure the best possible distribution of fuel, in this case oxygen carried in the blood, to the engine, the heart and brain. However, if there is no fuel (oxygen) in the system, replacing the pump (manual contractions of the heart) will be of little to no benefit.
So, in cases where there is still an adequate supply of oxygen in the blood, as in the case of a witnessed collapse from cardiac arrest, some recent reports have shown that compression only CPR results in significantly better survival rates. An additional time when compression only CPR can be beneficial is when a rescuer is hesitant to provide traditional CPR, either due to lack of knowledge, or due to concerns about communicable diseases. However, in the case where there is the potential for a significantly diminished levels of oxygen in the blood, as in the case of unwitnessed cardiac arrest, and cardiac arrest caused by chocking, drowning, or respiratory issues (as is often the case with infants and children) traditional CPR will most likely provided the greatest benefit to the patient. So then, there really is no one-size-fits-all resolution to this debate. It will be interesting see what evidence future studies bring to the table and how CPR training guidelines are affected by these. We will just have to wait and see.
You may find the following links related to this topic to be of interest:
American Heart Association Compression Only CPR Worksheet
PubMed Directory Listing of Compression Only CPR Articles