Current evidence of survival benefit between chest-compression only versus standard cardiopulmonary resuscitation in out
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I. Ivan · F. Budiman · R. Ruby · I. P. Wendi · D. A. Ridjab School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
Current evidence of survival benefit between chestcompression only versus standard cardiopulmonary resuscitation in out-of-hospital cardiac arrest Updated systematic review and metaanalysis of randomized controlled trials with trial sequential analysis
Introduction Cardiac arrest is the third leading cause of death worldwide [1]. Despite current advances intechnology, especiallyinhandling cardiovascular disease, in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) remain the leading causes of mortality and morbidity globally. In the developing countries, OHCA contributes around 10% of the total mortality [2]. The key predictors of survival in OHCA patients are determined by immediate bystander cardiopulmonary resuscitation (CPR), early defibrillation, early emergency medical services (EMS) response, and postresuscitation care [2]. These steps are commonly known as the “chain of survival”. As part of the “chain of survival”, CPR comprises a major part in increasing chances of living in OHCA patients. The goal of CPR is to maintain oxygenation until spontaneous circulation is restored [3]. Current CPR includes chest compressions and rescue breathing, either with mouthto-mouth ventilation or an artificial device. While standard chest compression (STD) include chest compressions
and rescue breathing, continuous chest compressions (CCC) requires no rescue breathing and thus increasing the rate of chest compressions per minute. The debate between CCC-CPR and STD-CPRwithinterrupted rescue breathing remains controversial, as CCC-CPR offers the advantage of continuing circulation, while the STD-CPR aims to provide adequate ventilation. The 2015 International Consensus on CPR and Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR) recommends continuous chest compression CPR for adults with suspected OHCA. CCC-CPR is simpler, easier to learn and perform. The American Heart Association (AHA) also stated that CCC-CPR is as effective as STDCPR for cardiac arrest at home, at work or in public [4]. It is expected to increase the rate of OHCA patients receiving bystander CPR. Increasing the rate of patients receiving bystander CPR is the key in strengthening the overall “chain of survival”. The willingness to perform CPR is associated with fear of acquiring infectious diseases from performing mouth-to-mouth ventilation [5]. Sense of panic and cultural
beliefs also prevented many bystanders to perform CPR [4, 6]. It is interesting to note that women with OHCA receive bystander CPR less often than men [7]. The reasons behind this are fear of being accused of inappropriate touch or sexual assault. CCC-CPR offers a higher number of chest compressions due to uninterrupted chest compressions [8]. Previous studies stated that higher chest compression rates significantly correlated with return of spontaneous circulation and better neur
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