Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study

Lancet. 2007 Mar 17;369(9565):920-6. doi: 10.1016/S0140-6736(07)60451-6.

Abstract

Background: Mouth-to-mouth ventilation is a barrier to bystanders doing cardiopulmonary resuscitation (CPR), but few clinical studies have investigated the efficacy of bystander resuscitation by chest compressions without mouth-to-mouth ventilation (cardiac-only resuscitation).

Methods: We did a prospective, multicentre, observational study of patients who had out-of-hospital cardiac arrest. On arrival at the scene, paramedics assessed the technique of bystander resuscitation. The primary endpoint was favourable neurological outcome 30 days after cardiac arrest.

Findings: 4068 adult patients who had out-of-hospital cardiac arrest witnessed by bystanders were included; 439 (11%) received cardiac-only resuscitation from bystanders, 712 (18%) conventional CPR, and 2917 (72%) received no bystander CPR. Any resuscitation attempt was associated with a higher proportion having favourable neurological outcomes than no resuscitation (5.0%vs 2.2%, p<0.0001). Cardiac-only resuscitation resulted in a higher proportion of patients with favourable neurological outcomes than conventional CPR in patients with apnoea (6.2%vs 3.1%; p=0.0195), with shockable rhythm (19.4%vs 11.2%, p=0.041), and with resuscitation that started within 4 min of arrest (10.1%vs 5.1%, p=0.0221). However, there was no evidence for any benefit from the addition of mouth-to-mouth ventilation in any subgroup. The adjusted odds ratio for a favourable neurological outcome after cardiac-only resuscitation was 2.2 (95% CI 1.2-4.2) in patients who received any resuscitation from bystanders.

Interpretation: Cardiac-only resuscitation by bystanders is the preferable approach to resuscitation for adult patients with witnessed out-of-hospital cardiac arrest, especially those with apnoea, shockable rhythm, or short periods of untreated arrest.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Cardiopulmonary Resuscitation / methods*
  • Cardiopulmonary Resuscitation / statistics & numerical data
  • Caregivers
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Heart Arrest / complications
  • Heart Arrest / therapy*
  • Heart Massage / methods*
  • Heart Massage / statistics & numerical data
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Nervous System Diseases / etiology
  • Observation
  • Prospective Studies
  • Sex Distribution
  • Survival Analysis
  • Treatment Outcome