Outcomes of chest compression only CPR versus conventional CPR conducted by lay people in patients with out of hospital cardiopulmonary arrest witnessed by bystanders: nationwide population based observational studyBMJ 2011; 342 doi: https://doi.org/10.1136/bmj.c7106 (Published 27 January 2011) Cite this as: BMJ 2011;342:c7106
All rapid responses
I read with a particular interest the paper of Ogawa T et al.(1)
Conventional cardiopulmonary resuscitation (CPR) seems to provide better 1
month outcome than Chest compression only CPR. The benefit attributable to
conventional CPR is 14.5% (equivalent of Levine's attributable fraction,
although contestable, gave an approximation of what it adds)(2), but
increase considerably if considered the case of cardiac origin with a
delayed by 9-10 minutes (86.4%, from data extracted in the editorial).(3)
It raised, such as the editorialist highlighted, that definitive evidence
is lacking taking into account the observational design where some hidden
reasons for the choice of the cardiopulmonary resuscitation method by the
witness. Indeed, in the Ogawa study et al, comparisons of the two groups
suggest, without demonstrating, that better training of the conventional
CPR group (lower proportion of Dispatcher assisted CPR, higher proportion
of AED by bystander, possibly the lower proportion of family members) in
the conventional CPR group than in the chest compression only CPR group.
This result has been also found in another study in a different continent,
with a similar result.(4)
Thus, although evidence is lacking, Ogawa et al study provide
additional information of the benefit of CPR to confirm ILCOR
guidelines(5) on what basic life support added.
1. Ogawa T, Akahane M, Koike S, Tanabe S, Mizoguchi T, Imamura T.
Outcomes of chest compression only CPR versus conventional CPR conducted
by lay people in patients with out of hospital cardiopulmonary arrest
witnessed by bystanders: nationwide population based observational study.
BMJ [Internet]. 2011 Jan 1;342. Available from:
2. Greenland S. Attributable fractions: bias from broad definition of
exposure. Epidemiology. 2001 Sep;12(5):518-520.
3. Jacobs IG. Chest compression or conventional CPR after out of
hospital cardiac arrest? BMJ [Internet]. 2011 Jan 1;342. Available from:
4. Jost D, Descatha A, Banville I, Verret C, Carpentier JP. Does bystander
-initiated chest compressions-only result in better patient outcome than
full cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac
arrest? Unexpected result from a post-hoc analysis of the DEFI 2005 Trial.
Resuscitation. 2011 Jan;82(1):130-131.
5. Hazinski MF, Nolan JP, Billi JE, B?ttiger BW, Bossaert L, de Caen
AR, et al. Part 1: executive summary: 2010 International Consensus on
Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science
With Treatment Recommendations. Circulation. 2010 Oct 19;122(16 Suppl
Competing interests: No competing interests