BYSTANDER CARDIOPULMONARY-RESUSCITATION - IS VENTILATION NECESSARY

Background. Prompt initiation of bystander cardiopulmonary resuscitati on (CPR) improves survival. Basic life support with mouth-to-mouth ven tilation and chest compressions is intimidating, difficult to remember , and difficult to perform. Chest compressions alone can be easily tau ght, easily remembered, easily performed, adequately taught by dispatc her-delivered telephone instruction, and more readily accepted by the public. The principal objective of this study was to evaluate the need for ventilation during CPR in a clinically relevant swine model of pr ehospital witnessed cardiac arrest. Methods and Results. Thirty second s after ventricular fibrillation, swine were randomly assigned to 12 m inutes of chest compressions plus mechanical ventilation (group A), ch est compressions only (group B), or no CPR (group C). Standard advance d cardiac life support was then provided. Animals successfully resusci tated were supported for 2 hours in an intensive care setting, and the n observed for 24 hours. All 16 swine in groups A and B were successfu lly resuscitated and neurologically normal at 24 hours, whereas only 2 of 8 group C animals survived for 24 hours (P<.001, Fisher's exact te st). One of the 2 group C survivors was comatose and unresponsive. Con clusions. In this swine model of witnessed prehospital cardiac arrest, the survival and neurological outcome data establish that prompt init iation of chest compressions alone appears to be as effective as chest compressions plus ventilation and that both techniques of bystander C PR markedly improve outcome compared with no bystander CPR.