The frequency and consequences of cardiopulmonary resuscitation performed by bystanders on patients who are not in cardiac arrest

Prehosp Emerg Care. 2011 Apr-Jun;15(2):282-7. doi: 10.3109/10903127.2010.541981. Epub 2011 Jan 20.


Background: The American Heart Association encourages trained and untrained bystanders to perform, at a minimum, chest compressions on anyone who suddenly collapses. It is possible that people who are not in cardiac arrest may receive bystander cardiopulmonary resuscitation (CPR), from which the potential for injury is unknown.

Objectives: To determine the number of victims who received bystander CPR but were not in cardiac arrest and to identify any injuries resulting from receiving bystander CPR.

Methods: Retrospective review of patient care records from a countywide emergency medical services (EMS) database. All patients treated by EMS between March 2003 and February 2009 who received bystander CPR were queried. Victims who were determined not to be in cardiac arrest upon EMS personnel assessment were identified as likely not in cardiac arrest. Hospital medical records for transported patients were reviewed for injuries possibly related to CPR. Patient demographics were collected and descriptive statistics were used for analysis.

Results: Six hundred seventy-two incidents of bystander CPR occurred, with 77 (11.5%) cases not being identified as cardiac arrests by EMS. Twenty-three percent of the patients were less than 19 years of age. Emergency medical services arrived in less than 6 minutes for 68% of patients. Seventy-two patients were evaluable for injury; of those, 53% were admitted to the intensive care unit. One patient (1.4%) had an injury that was documented in the medical record as possibly CPR-related: rhabdomyolysis.

Conclusions: Bystanders provide CPR for patients who are not in cardiac arrest at a relatively low frequency. Short-duration bystander CPR caused injury in less than 2% of victims. Our results suggest that the benefits of bystander CPR for adults who suddenly collapse outweigh the risk of injury for those not in cardiac arrest.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • American Heart Association
  • Cardiopulmonary Resuscitation / adverse effects*
  • Cardiopulmonary Resuscitation / methods
  • Chest Wall Oscillation / adverse effects*
  • Emergency Medical Technicians
  • Female
  • Humans
  • Male
  • Middle Aged
  • Out-of-Hospital Cardiac Arrest*
  • Retrospective Studies
  • Risk Factors
  • United States / epidemiology
  • Wounds and Injuries / epidemiology
  • Wounds and Injuries / etiology*
  • Young Adult