The optimal resuscitation method for out-of-hospital cardiac arrest remains controversial. Although current basic life-support guidelines recommend both chest compressions and rescue ventilation, more recent evidence has questioned the usefulness of rescue ventilation.

The authors of this meta-analysis compared studies published between January 1985 and August 2010 that compared chest-compression-only bystander cardiopulmonary resuscitation (CPR) with standard CPR. In the primary meta-analysis, randomised trials in which patients were allocated to one of the two techniques (according to dispatcher instructions) were included. In the secondary meta-analysis, observational cohort studies of chest-compression-only CPR were also included. The primary outcome was survival to hospital discharge.

In the primary meta-analysis, data from three randomised controlled trials indicated that chest-compression-only CPR was associated with an improved chance of survival compared with standard CPR (14% vs 12%; absolute increase in survival 2.4%, number needed to treat=41, figure 1). In the secondary meta-analysis (of seven observational cohort studies), no difference was recorded between the two techniques (8% vs 8%). However, none of these observational studies examined dispatcher-assisted CPR.

Conclusions

Bystanders should be instructed to perform chest-compression-only CPR at the scene of a cardiac arrest.

▶ Hupfl M, Selig HF, Nagele P. Chest-compression-only versus standard cardiopulmonary resuscitation: a meta-analysis. Lancet 2010;376:1552–7.