Cardiopulmonary resuscitation by chest compression alone or with mouth-to-mouth ventilation

Background: Despite extensive training of citizens of Seattle in cardiopulm onary resuscitation (CPR), bystanders do not perform CPR in almost half of witnessed cardiac arrests. Instructions in chest compression plus mouth-to- mouth ventilation given by dispatchers over the telephone can require 2.4 m inutes. In experimental studies, chest compression alone is associated with survival rates similar to those with chest compression plus mouth-to-mouth ventilation. We conducted a randomized study to compare CPR by chest compr ession alone with CPR by chest compression plus mouth-to-mouth ventilation. Methods: The setting of the trial was an urban, fire-department-based, emer gency-medical-care system with central dispatching. In a randomized manner, telephone dispatchers gave bystanders at the scene of apparent cardiac arr est instructions in either chest compression alone or chest compression plu s mouth-to-mouth ventilation. The primary end point was survival to hospita l discharge. Results: Data were analyzed for 241 patients randomly assigned to receive c hest compression alone and 279 assigned to chest compression plus mouth-to- mouth ventilation. Complete instructions were delivered in 62 percent of ep isodes for the group receiving chest compression plus mouth-to-mouth ventil ation and 81 percent of episodes for the group receiving chest compression alone (P=0.005). Instructions for compression required 1.4 minutes less to complete than instructions for compression plus mouth-to-mouth ventilation. Survival to hospital discharge was better among patients assigned to chest compression alone than among those assigned to chest compression plus mout h-to-mouth ventilation (14.6 percent vs. 10.4 percent), but the difference was not statistically significant (P=0.18). Conclusions: The outcome after CPR with chest compression alone is similar to that after chest compression with mouth-to-mouth ventilation, and chest compression alone may be the preferred approach for bystanders inexperience d in CPR. (N Engl J Med 2000;342:1546-53.) (C) 2000, Massachusetts Medical Society.