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Robert A Berg - One of the best experts on this subject based on the ideXlab platform.
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compression only versus Rescue Breathing cardiopulmonary resuscitation after pediatric out of hospital cardiac arrest
Journal of the American College of Cardiology, 2021Co-Authors: Maryam Y Naim, Robert A Berg, Vinay Nadkarni, Heather Griffis, Richard N Bradley, Rita V Burke, David Markenson, Bryan Mcnally, Lihai Song, Kimberly VellanoAbstract:Abstract Background There are conflicting data regarding the benefit of compression-only bystander cardiopulmonary resuscitation (CO-CPR) compared with CPR with Rescue Breathing (RB-CPR) after pediatric out-of-hospital cardiac arrest (OHCA). Objectives This study sought to test the hypothesis that RB-CPR is associated with improved neurologically favorable survival compared with CO-CPR following pediatric OHCA, and to characterize age-stratified outcomes with CPR type compared with no bystander CPR (NO-CPR). Methods Analysis of the CARES registry (Cardiac Arrest Registry to Enhance Survival) for nontraumatic pediatric OHCAs (patients aged ≤18 years) from 2013-2019 was performed. Age groups included infants ( Results Of 13,060 pediatric OHCAs, 46.5% received bystander CPR. CO-CPR was the most common bystander CPR type. In the overall cohort, neurologically favorable survival was associated with RB-CPR (adjusted OR: 2.16; 95% CI: 1.78-2.62) and CO-CPR (adjusted OR: 1.61; 95% CI: 1.34-1.94) compared with NO-CPR. RB-CPR was associated with a higher odds of neurologically favorable survival compared with CO-CPR (adjusted OR: 1.36; 95% CI: 1.10-1.68). In age-stratified analysis, RB-CPR was associated with better neurologically favorable survival versus NO-CPR in all age groups. CO-CPR was associated with better neurologically favorable survival compared with NO-CPR in children and adolescents, but not in infants. Conclusions CO-CPR was the most common type of bystander CPR in pediatric OHCA. RB-CPR was associated with better outcomes compared with CO-CPR. These results support present guidelines for RB-CPR as the preferred CPR modality for pediatric OHCA.
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when should Rescue Breathing be removed from the abcs of cpr
Critical Care Clinics, 2012Co-Authors: David D Berg, Robert A BergAbstract:Cardiac arrest is a major public health problem and a leading cause of death in the United States. Nearly 300,000 Americans sustain out-of-hospital cardiac arrests OHCAs) each year, and cardiopulmonary resuscitation (CPR) is provided by emerency medical professionals for approximately 175,000 of these OHCA victims each ear. Although prompt initiation of bystander CPR substantially improves the hances of survival from OHCA, most cardiac arrest victims do not receive bystander PR. In-hospital cardiac arrests (IHCAs) and CPR are also relatively common. A ecent study has established that CPR is provided for approximately 200,000 ospitalized patients each year. Fifty years ago, Kouwenhoven and colleagues demonstrated that “closed hest cardiac massage” resulted in successful return of spontaneous circulation or 20 consecutive patients with IHCAs. Their animal studies showed that closed hest cardiac massage (without Rescue Breathing) was an effective technique to aintain circulation of dogs in ventricular fibrillation (VF) for up to 30 minutes, hereby allowing successful defibrillation and return of spontaneous circulation. herefore, the initial patients in this clinical series received chest compressions ithout artificial respiration. Artificial respiration was soon added to closed chest ardiac massage because of the presumed need for adequate oxygenation and entilation. The new bundle was taught as the ABCs of CPR.
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time dependent effectiveness of chest compression only and conventional cardiopulmonary resuscitation for out of hospital cardiac arrest of cardiac origin
Resuscitation, 2011Co-Authors: Tetsuhisa Kitamura, Taku Iwami, Robert A Berg, Takashi Kawamura, Ken Nagao, Hideharu Tanaka, Atsushi HiraideAbstract:Abstract Background Little is known about the effect of the type of bystander-initiated cardiopulmonary resuscitation (CPR) for prolonged out-of-hospital cardiac arrest (OHCA). Objectives To evaluate the time-dependent effectiveness of chest compression-only and conventional CPR with Rescue Breathing for witnessed adult OHCA of cardiac origin. Methods A nationwide, prospective, population-based, observational study of the whole population of Japan included consecutive OHCA patients with emergency responder resuscitation attempts from 1 January 2005 to 31 December 2007. Multiple logistic regression analysis was performed to assess the contribution of the bystander-initiated CPR technique to favourable neurological outcomes. Results Among 55014 bystander-witnessed OHCA of cardiac origin, 12165 (22.1%) received chest compression-only CPR and 10851 (19.7%) received conventional CPR. For short-duration OHCA (0–15min after collapse), compression-only CPR had a higher rate of survival with favourable neurological outcome than no CPR (6.4% vs. 3.8%; adjusted odds ratio (OR), 1.55; 95% confidence interval (CI), 1.38–1.74), and conventional CPR showed similar effectiveness (7.1% vs. 3.8%; adjusted OR, 1.78; 95% CI, 1.58–2.01). For the long-duration arrests (>15min), conventional CPR showed a significantly higher rate of survival with favourable neurological outcome than both no CPR (2.0% vs. 0.7%; adjusted OR, 1.93; 95% CI, 1.27–2.93) and compression-only CPR (2.0% vs. 1.3%; adjusted OR, 1.56; 95% CI, 1.02–2.44). Conclusions For prolonged OHCA of cardiac origin, conventional CPR with Rescue Breathing provided incremental benefit compared with either no CPR or compression-only CPR, but the absolute survival was low regardless of type of CPR.
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part 1 executive summary 2010 american heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care
Circulation, 2010Co-Authors: John M. Field, Robert A Berg, Leon Chameides, Mary Fran Hazinski, Michael R Sayre, Stephen M Schexnayder, Robin Hemphill, Ricardo A Samson, John Kattwinkel, Farhan BhanjiAbstract:The publication of the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care marks the 50th anniversary of modern CPR. In 1960 Kouwenhoven, Knickerbocker, and Jude documented 14 patients who survived cardiac arrest with the application of closed chest cardiac massage.1 That same year, at the meeting of the Maryland Medical Society in Ocean City, MD, the combination of chest compressions and Rescue Breathing was introduced.2 Two years later, in 1962, direct-current, monophasic waveform defibrillation was described.3 In 1966 the American Heart Association (AHA) developed the first cardiopulmonary resuscitation (CPR) guidelines, which have been followed by periodic updates.4 During the past 50 years the fundamentals of early recognition and activation, early CPR, early defibrillation, and early access to emergency medical care have saved hundreds of thousands of lives around the world. These lives demonstrate the importance of resuscitation research and clinical translation and are cause to celebrate this 50th anniversary of CPR. Challenges remain if we are to fulfill the potential offered by the pioneer resuscitation scientists. We know that there is a striking disparity in survival outcomes from cardiac arrest across systems of care, with some systems reporting 5-fold higher survival rates than others.5,–,9 Although technology, such as that incorporated in automated external defibrillators (AEDs), has contributed to increased survival from cardiac arrest, no initial intervention can be delivered to the victim of cardiac arrest unless bystanders are ready, willing, and able to act. Moreover, to be successful, the actions of bystanders and other care providers must occur within a system that coordinates and integrates each facet of care into a comprehensive whole, focusing on survival to discharge from the hospital. This executive summary highlights the major changes and …
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uninterrupted chest compression cpr is easier to perform and remember than standard cpr
Resuscitation, 2004Co-Authors: Joseph W Heidenreich, Robert A Berg, Karl B Kern, Arthur B Sanders, Travis A Higdon, Gordon A EwyAbstract:Abstract Introduction : It has long been observed that CPR skills rapidly decline regardless of the modality used for teaching or criteria used for testing. Uninterrupted chest compression CPR (UCC-CPR) is a proposed alternative to standard single Rescuer CPR (STD-CPR) for laypersons in witnessed unexpected cardiac arrest in adults. It delivers substantially more compressions per minute and may be easier to remember and perform than standard CPR. Methods : In this prospective study, 28 medical students were taught STD-CPR and UCC-CPR and then were tested on each method at baseline (0), 6, and 18 months after training. The students' performance for at least 90s of CPR was evaluated based on video and Laerdal Skillreporter Resusci Anne recordings. Results : The mean number of correct chest compressions delivered per minute trended down over time in STD-CPR (23±3, 19±4, and 15±3; P = 0.09) but stayed the same in UCC-CPR (43±9, 38±7, and 37±7; P = 0.91) at 0, 6, and 18 months, respectively. The mean percentage of chest compressions delivered correctly fell over time in STD-CPR (54±6%, 35±6%, and 32±6%; P = 0.02) but stayed the same in UCC-CPR (34±5%, 41±7%, and 38±8%) at 0, 6, and 18 months, respectively. The number of chest compressions delivered per minute was higher in UCC-CPR at 0, 6, and 18 months (113 versus 44, P P P Conclusions : Chest compression performance during STD-CPR declined in repeated testing over 18 months whereas there was minimal decline in chest compressions performance on repeated testing of UCC-CPR. In addition, substantially more chest compressions were delivered during UCC-CPR compared to STD-CPR at all time points primarily because of long pauses accompanying Rescue Breathing.
Takashi Kawamura - One of the best experts on this subject based on the ideXlab platform.
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dissemination of chest compression only cardiopulmonary resuscitation and survival after out of hospital cardiac arrest
Circulation, 2015Co-Authors: Taku Iwami, Tetsuhisa Kitamura, Kosuke Kiyohara, Takashi KawamuraAbstract:Background—The best cardiopulmonary resuscitation (CPR) technique for survival after out-of-hospital cardiac arrests (OHCAs) has been intensively discussed in the recent few years. However, most analyses focused on comparison at the individual level. How well the dissemination of bystander-initiated chest compression–only CPR (CCCPR) increases survival after OHCAs at the population level remains unclear. We therefore evaluated the impact of nationwide dissemination of bystander-initiated CCCPR on survival after OHCA. Methods and Results—A nationwide, prospective, population-based, observational study covering the whole population of Japan and involving consecutive OHCA patients with resuscitation attempts was conducted from January 2005 through December 2012. The main outcome measure was 1-month survival with favorable neurological outcome. The incidence of survival with favorable neurological outcome attributed to types of bystander CPR (CCCPR and conventional CPR with Rescue Breathing) was estimated. Am...
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long term retention of cardiopulmonary resuscitation skills after shortened chest compression only training and conventional training a randomized controlled trial
Academic Emergency Medicine, 2014Co-Authors: Chika Nishiyama, Taku Iwami, Tetsuhisa Kitamura, Tetsuya Sakamoto, Seishiro Marukawa, Masahiko Ando, Takashi KawamuraAbstract:Objectives It is unclear how much the length of a cardiopulmonary resuscitation (CPR) training program can be reduced without ruining its effectiveness. The authors aimed to compare CPR skills 6 months and 1 year after training between shortened chest compression–only CPR training and conventional CPR training. Methods Participants were randomly assigned to either the compression-only CPR group, which underwent a 45-minute training program consisting of chest compressions and automated external defibrillator (AED) use with personal training manikins, or the conventional CPR group, which underwent a 180-minute training program with chest compressions, Rescue Breathing, and AED use. Participants' resuscitation skills were evaluated 6 months and 1 year after the training. The primary outcome measure was the proportion of appropriate chest compressions 1 year after the training. Results A total of 146 persons were enrolled, and 63 (87.5%) in the compression-only CPR group and 56 (75.7%) in the conventional CPR group completed the 1-year evaluation. The compression-only CPR group was superior to the conventional CPR group regarding the proportion of appropriate chest compression (mean ± SD = 59.8% ± 40.0% vs. 46.3% ± 28.6%; p = 0.036) and the number of appropriate chest compressions (mean ± SD = 119.5 ± 80.0 vs. 77.2 ± 47.8; p = 0.001). Time without chest compression in the compression-only CPR group was significantly shorter than that in the conventional CPR group (mean ± SD = 11.8 ± 21.1 seconds vs. 52.9 ± 14.9 seconds; p < 0.001). Conclusions The shortened compression-only CPR training program appears to help the general public retain CPR skills better than the conventional CPR training program. Resumen Objetivos No esta claro a cuanto tiempo se puede reducir un programa de formacion en resucitacion cardiopulmonar (RCP) sin afectar a su efectividad. El objetivo fue comparar las habilidades de RCP a los 6 meses y un ano tras la formacion entre una formacion de RCP abreviada de solo compresion toracica y una formacion en RCP convencional. Metodologia Los participantes se asignaron de forma aleatoria bien al grupo RCP de solo comprension que llevo a cabo un programa de formacion de 45 minutos consistente en las compresiones toracicas y a uso de desfibrilador externo automatico con maniqui de formacion personal; o bien el grupo de RCP convencional que llevo a cabo un programa de formacion de 180 minutos con la compresion toracica, la recuperacion de la respiracion y el uso de desfibrilador externo automatico. Las habilidades de resucitacion de los participantes se evaluaron a los 6 meses y al ano tras la formacion. La variable de resultado principal fue la proporcion de compresiones toracicas al ano de haber realizado la formacion. Resultados Se incluyeron 146 personas, de las cuales 63 (87,5%) en el grupo de RCP solo compresion y 56 (75,7%) en el grupo de RCP convencional completaron la evaluacion al ano. El grupo de RCP con solo compresion fue superior al grupo RCP convencional en relacion a la proporcion de compresiones toracicas apropiadas (59,8% [DE ± 40,0%] vs. 46,3% [DE ± 28,6%] p = 0,036), y al numero de compresiones toracicas apropiadas (119,5 [DE ± 80,0] vs. 77,2 [DE ± 47.8] p = 0.001). El tiempo sin compresion toracica en el grupo RCP con solo compresion (11,8 segundos [DE ± 21,1 segundos]) fue significativamente mas corto que el del grupo RCP convencional (52,9 segundos [DE ± 14.9 segundos], p < 0,001). Conclusiones El programa de formacion abreviado de solo compresion podria ayudar al publico general a retener las habilidades en RCP mejor que el programa de formacion RCP convencional.
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chest compression only cardiopulmonary resuscitation for out of hospital cardiac arrest with public access defibrillation a nationwide cohort study
Circulation, 2012Co-Authors: Taku Iwami, Tetsuhisa Kitamura, Takashi Kawamura, Ken Nagao, Hideharu Tanaka, Hideo Mitamura, Morimasa Takayama, Yoshihiko Seino, Hiroshi Nonogi, Naohiro YonemotoAbstract:Background—It remains unclear which is more effective to increase survival after out-of-hospital cardiac arrest in those with public-access defibrillation, bystander-initiated chest compression–only cardiopulmonary resuscitation (CPR) or conventional CPR with Rescue Breathing. Methods and Results—A nationwide, prospective, population-based observational study covering the whole population of Japan and involving consecutive out-of-hospital cardiac arrest patients with resuscitation attempts has been conducted since 2005. We enrolled all out-of-hospital cardiac arrests of presumed cardiac origin that were witnessed and received shocks with public-access automated external defibrillation (AEDs) by bystanders from January 1, 2005, to December 31, 2009. The main outcome measure was neurologically favorable 1-month survival. We compared outcomes by type of bystander-initiated CPR (chest compression–only CPR and conventional CPR with compressions and Rescue Breathing). Multivariable logistic regression was used to assess the relationship between the type of CPR and a better neurological outcome. During the 5 years, 1376 bystander-witnessed out-of-hospital cardiac arrests of cardiac origin in individuals who received CPR and shocks with public-access AEDs by bystanders were registered. Among them, 506 (36.8%) received chest compression–only CPR and 870 (63.2%) received conventional CPR. The chest compression– only CPR group (40.7%, 206 of 506) had a significantly higher rate of 1-month survival with favorable neurological outcome than the conventional CPR group (32.9%, 286 of 870; adjusted odds ratio, 1.33; 95% confidence interval, 1.03–1.70). Conclusions—Compression-only CPR is more effective than conventional CPR for patients in whom out-of-hospital cardiac arrest is witnessed and shocked with public-access defibrillation. Compression-only CPR is the most likely scenario in which lay Rescuers can witness a sudden collapse and use public-access AEDs. (Circulation. 2012;126:2844-2851.)
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Response to Letters Regarding Article, “Bystander-Initiated Rescue Breathing for Out-of-Hospital Cardiac Arrests of Noncardiac Origin”
Circulation, 2011Co-Authors: Tetsuhisa Kitamura, Taku Iwami, Takashi Kawamura, Ken Nagao, Hideharu Tanaka, Atsushi HiraideAbstract:We thank Dr Rai, Dr Arrich, and their colleagues for their relevant comments on our article.1 As Rai and colleagues pointed out, the recent randomized, controlled trial2 of dispatcher instructions to bystanders for performing cardiopulmonary resuscitation (CPR) failed to show statistical differences between chest compression-only and conventional CPR with Rescue Breathing in its subgroup analysis: the good neurological outcome after out-of-hospital cardiac arrests (OHCAs) of noncardiac origin was 6.9% (13/188) in the conventional CPR group and 4.4% (9/204) in the compression-only CPR group ( P =0.28). This might be due to its small sample size, and the results are consistent with ours. Since survival after OHCAs of noncardiac origin is generally low regardless of type of CPR, a large sample size is needed to address this issue, and our study …
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time dependent effectiveness of chest compression only and conventional cardiopulmonary resuscitation for out of hospital cardiac arrest of cardiac origin
Resuscitation, 2011Co-Authors: Tetsuhisa Kitamura, Taku Iwami, Robert A Berg, Takashi Kawamura, Ken Nagao, Hideharu Tanaka, Atsushi HiraideAbstract:Abstract Background Little is known about the effect of the type of bystander-initiated cardiopulmonary resuscitation (CPR) for prolonged out-of-hospital cardiac arrest (OHCA). Objectives To evaluate the time-dependent effectiveness of chest compression-only and conventional CPR with Rescue Breathing for witnessed adult OHCA of cardiac origin. Methods A nationwide, prospective, population-based, observational study of the whole population of Japan included consecutive OHCA patients with emergency responder resuscitation attempts from 1 January 2005 to 31 December 2007. Multiple logistic regression analysis was performed to assess the contribution of the bystander-initiated CPR technique to favourable neurological outcomes. Results Among 55014 bystander-witnessed OHCA of cardiac origin, 12165 (22.1%) received chest compression-only CPR and 10851 (19.7%) received conventional CPR. For short-duration OHCA (0–15min after collapse), compression-only CPR had a higher rate of survival with favourable neurological outcome than no CPR (6.4% vs. 3.8%; adjusted odds ratio (OR), 1.55; 95% confidence interval (CI), 1.38–1.74), and conventional CPR showed similar effectiveness (7.1% vs. 3.8%; adjusted OR, 1.78; 95% CI, 1.58–2.01). For the long-duration arrests (>15min), conventional CPR showed a significantly higher rate of survival with favourable neurological outcome than both no CPR (2.0% vs. 0.7%; adjusted OR, 1.93; 95% CI, 1.27–2.93) and compression-only CPR (2.0% vs. 1.3%; adjusted OR, 1.56; 95% CI, 1.02–2.44). Conclusions For prolonged OHCA of cardiac origin, conventional CPR with Rescue Breathing provided incremental benefit compared with either no CPR or compression-only CPR, but the absolute survival was low regardless of type of CPR.
Tetsuhisa Kitamura - One of the best experts on this subject based on the ideXlab platform.
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dissemination of chest compression only cardiopulmonary resuscitation and survival after out of hospital cardiac arrest
Circulation, 2015Co-Authors: Taku Iwami, Tetsuhisa Kitamura, Kosuke Kiyohara, Takashi KawamuraAbstract:Background—The best cardiopulmonary resuscitation (CPR) technique for survival after out-of-hospital cardiac arrests (OHCAs) has been intensively discussed in the recent few years. However, most analyses focused on comparison at the individual level. How well the dissemination of bystander-initiated chest compression–only CPR (CCCPR) increases survival after OHCAs at the population level remains unclear. We therefore evaluated the impact of nationwide dissemination of bystander-initiated CCCPR on survival after OHCA. Methods and Results—A nationwide, prospective, population-based, observational study covering the whole population of Japan and involving consecutive OHCA patients with resuscitation attempts was conducted from January 2005 through December 2012. The main outcome measure was 1-month survival with favorable neurological outcome. The incidence of survival with favorable neurological outcome attributed to types of bystander CPR (CCCPR and conventional CPR with Rescue Breathing) was estimated. Am...
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long term retention of cardiopulmonary resuscitation skills after shortened chest compression only training and conventional training a randomized controlled trial
Academic Emergency Medicine, 2014Co-Authors: Chika Nishiyama, Taku Iwami, Tetsuhisa Kitamura, Tetsuya Sakamoto, Seishiro Marukawa, Masahiko Ando, Takashi KawamuraAbstract:Objectives It is unclear how much the length of a cardiopulmonary resuscitation (CPR) training program can be reduced without ruining its effectiveness. The authors aimed to compare CPR skills 6 months and 1 year after training between shortened chest compression–only CPR training and conventional CPR training. Methods Participants were randomly assigned to either the compression-only CPR group, which underwent a 45-minute training program consisting of chest compressions and automated external defibrillator (AED) use with personal training manikins, or the conventional CPR group, which underwent a 180-minute training program with chest compressions, Rescue Breathing, and AED use. Participants' resuscitation skills were evaluated 6 months and 1 year after the training. The primary outcome measure was the proportion of appropriate chest compressions 1 year after the training. Results A total of 146 persons were enrolled, and 63 (87.5%) in the compression-only CPR group and 56 (75.7%) in the conventional CPR group completed the 1-year evaluation. The compression-only CPR group was superior to the conventional CPR group regarding the proportion of appropriate chest compression (mean ± SD = 59.8% ± 40.0% vs. 46.3% ± 28.6%; p = 0.036) and the number of appropriate chest compressions (mean ± SD = 119.5 ± 80.0 vs. 77.2 ± 47.8; p = 0.001). Time without chest compression in the compression-only CPR group was significantly shorter than that in the conventional CPR group (mean ± SD = 11.8 ± 21.1 seconds vs. 52.9 ± 14.9 seconds; p < 0.001). Conclusions The shortened compression-only CPR training program appears to help the general public retain CPR skills better than the conventional CPR training program. Resumen Objetivos No esta claro a cuanto tiempo se puede reducir un programa de formacion en resucitacion cardiopulmonar (RCP) sin afectar a su efectividad. El objetivo fue comparar las habilidades de RCP a los 6 meses y un ano tras la formacion entre una formacion de RCP abreviada de solo compresion toracica y una formacion en RCP convencional. Metodologia Los participantes se asignaron de forma aleatoria bien al grupo RCP de solo comprension que llevo a cabo un programa de formacion de 45 minutos consistente en las compresiones toracicas y a uso de desfibrilador externo automatico con maniqui de formacion personal; o bien el grupo de RCP convencional que llevo a cabo un programa de formacion de 180 minutos con la compresion toracica, la recuperacion de la respiracion y el uso de desfibrilador externo automatico. Las habilidades de resucitacion de los participantes se evaluaron a los 6 meses y al ano tras la formacion. La variable de resultado principal fue la proporcion de compresiones toracicas al ano de haber realizado la formacion. Resultados Se incluyeron 146 personas, de las cuales 63 (87,5%) en el grupo de RCP solo compresion y 56 (75,7%) en el grupo de RCP convencional completaron la evaluacion al ano. El grupo de RCP con solo compresion fue superior al grupo RCP convencional en relacion a la proporcion de compresiones toracicas apropiadas (59,8% [DE ± 40,0%] vs. 46,3% [DE ± 28,6%] p = 0,036), y al numero de compresiones toracicas apropiadas (119,5 [DE ± 80,0] vs. 77,2 [DE ± 47.8] p = 0.001). El tiempo sin compresion toracica en el grupo RCP con solo compresion (11,8 segundos [DE ± 21,1 segundos]) fue significativamente mas corto que el del grupo RCP convencional (52,9 segundos [DE ± 14.9 segundos], p < 0,001). Conclusiones El programa de formacion abreviado de solo compresion podria ayudar al publico general a retener las habilidades en RCP mejor que el programa de formacion RCP convencional.
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chest compression only cardiopulmonary resuscitation for out of hospital cardiac arrest with public access defibrillation a nationwide cohort study
Circulation, 2012Co-Authors: Taku Iwami, Tetsuhisa Kitamura, Takashi Kawamura, Ken Nagao, Hideharu Tanaka, Hideo Mitamura, Morimasa Takayama, Yoshihiko Seino, Hiroshi Nonogi, Naohiro YonemotoAbstract:Background—It remains unclear which is more effective to increase survival after out-of-hospital cardiac arrest in those with public-access defibrillation, bystander-initiated chest compression–only cardiopulmonary resuscitation (CPR) or conventional CPR with Rescue Breathing. Methods and Results—A nationwide, prospective, population-based observational study covering the whole population of Japan and involving consecutive out-of-hospital cardiac arrest patients with resuscitation attempts has been conducted since 2005. We enrolled all out-of-hospital cardiac arrests of presumed cardiac origin that were witnessed and received shocks with public-access automated external defibrillation (AEDs) by bystanders from January 1, 2005, to December 31, 2009. The main outcome measure was neurologically favorable 1-month survival. We compared outcomes by type of bystander-initiated CPR (chest compression–only CPR and conventional CPR with compressions and Rescue Breathing). Multivariable logistic regression was used to assess the relationship between the type of CPR and a better neurological outcome. During the 5 years, 1376 bystander-witnessed out-of-hospital cardiac arrests of cardiac origin in individuals who received CPR and shocks with public-access AEDs by bystanders were registered. Among them, 506 (36.8%) received chest compression–only CPR and 870 (63.2%) received conventional CPR. The chest compression– only CPR group (40.7%, 206 of 506) had a significantly higher rate of 1-month survival with favorable neurological outcome than the conventional CPR group (32.9%, 286 of 870; adjusted odds ratio, 1.33; 95% confidence interval, 1.03–1.70). Conclusions—Compression-only CPR is more effective than conventional CPR for patients in whom out-of-hospital cardiac arrest is witnessed and shocked with public-access defibrillation. Compression-only CPR is the most likely scenario in which lay Rescuers can witness a sudden collapse and use public-access AEDs. (Circulation. 2012;126:2844-2851.)
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Response to Letters Regarding Article, “Bystander-Initiated Rescue Breathing for Out-of-Hospital Cardiac Arrests of Noncardiac Origin”
Circulation, 2011Co-Authors: Tetsuhisa Kitamura, Taku Iwami, Takashi Kawamura, Ken Nagao, Hideharu Tanaka, Atsushi HiraideAbstract:We thank Dr Rai, Dr Arrich, and their colleagues for their relevant comments on our article.1 As Rai and colleagues pointed out, the recent randomized, controlled trial2 of dispatcher instructions to bystanders for performing cardiopulmonary resuscitation (CPR) failed to show statistical differences between chest compression-only and conventional CPR with Rescue Breathing in its subgroup analysis: the good neurological outcome after out-of-hospital cardiac arrests (OHCAs) of noncardiac origin was 6.9% (13/188) in the conventional CPR group and 4.4% (9/204) in the compression-only CPR group ( P =0.28). This might be due to its small sample size, and the results are consistent with ours. Since survival after OHCAs of noncardiac origin is generally low regardless of type of CPR, a large sample size is needed to address this issue, and our study …
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time dependent effectiveness of chest compression only and conventional cardiopulmonary resuscitation for out of hospital cardiac arrest of cardiac origin
Resuscitation, 2011Co-Authors: Tetsuhisa Kitamura, Taku Iwami, Robert A Berg, Takashi Kawamura, Ken Nagao, Hideharu Tanaka, Atsushi HiraideAbstract:Abstract Background Little is known about the effect of the type of bystander-initiated cardiopulmonary resuscitation (CPR) for prolonged out-of-hospital cardiac arrest (OHCA). Objectives To evaluate the time-dependent effectiveness of chest compression-only and conventional CPR with Rescue Breathing for witnessed adult OHCA of cardiac origin. Methods A nationwide, prospective, population-based, observational study of the whole population of Japan included consecutive OHCA patients with emergency responder resuscitation attempts from 1 January 2005 to 31 December 2007. Multiple logistic regression analysis was performed to assess the contribution of the bystander-initiated CPR technique to favourable neurological outcomes. Results Among 55014 bystander-witnessed OHCA of cardiac origin, 12165 (22.1%) received chest compression-only CPR and 10851 (19.7%) received conventional CPR. For short-duration OHCA (0–15min after collapse), compression-only CPR had a higher rate of survival with favourable neurological outcome than no CPR (6.4% vs. 3.8%; adjusted odds ratio (OR), 1.55; 95% confidence interval (CI), 1.38–1.74), and conventional CPR showed similar effectiveness (7.1% vs. 3.8%; adjusted OR, 1.78; 95% CI, 1.58–2.01). For the long-duration arrests (>15min), conventional CPR showed a significantly higher rate of survival with favourable neurological outcome than both no CPR (2.0% vs. 0.7%; adjusted OR, 1.93; 95% CI, 1.27–2.93) and compression-only CPR (2.0% vs. 1.3%; adjusted OR, 1.56; 95% CI, 1.02–2.44). Conclusions For prolonged OHCA of cardiac origin, conventional CPR with Rescue Breathing provided incremental benefit compared with either no CPR or compression-only CPR, but the absolute survival was low regardless of type of CPR.
Taku Iwami - One of the best experts on this subject based on the ideXlab platform.
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dissemination of chest compression only cardiopulmonary resuscitation and survival after out of hospital cardiac arrest
Circulation, 2015Co-Authors: Taku Iwami, Tetsuhisa Kitamura, Kosuke Kiyohara, Takashi KawamuraAbstract:Background—The best cardiopulmonary resuscitation (CPR) technique for survival after out-of-hospital cardiac arrests (OHCAs) has been intensively discussed in the recent few years. However, most analyses focused on comparison at the individual level. How well the dissemination of bystander-initiated chest compression–only CPR (CCCPR) increases survival after OHCAs at the population level remains unclear. We therefore evaluated the impact of nationwide dissemination of bystander-initiated CCCPR on survival after OHCA. Methods and Results—A nationwide, prospective, population-based, observational study covering the whole population of Japan and involving consecutive OHCA patients with resuscitation attempts was conducted from January 2005 through December 2012. The main outcome measure was 1-month survival with favorable neurological outcome. The incidence of survival with favorable neurological outcome attributed to types of bystander CPR (CCCPR and conventional CPR with Rescue Breathing) was estimated. Am...
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long term retention of cardiopulmonary resuscitation skills after shortened chest compression only training and conventional training a randomized controlled trial
Academic Emergency Medicine, 2014Co-Authors: Chika Nishiyama, Taku Iwami, Tetsuhisa Kitamura, Tetsuya Sakamoto, Seishiro Marukawa, Masahiko Ando, Takashi KawamuraAbstract:Objectives It is unclear how much the length of a cardiopulmonary resuscitation (CPR) training program can be reduced without ruining its effectiveness. The authors aimed to compare CPR skills 6 months and 1 year after training between shortened chest compression–only CPR training and conventional CPR training. Methods Participants were randomly assigned to either the compression-only CPR group, which underwent a 45-minute training program consisting of chest compressions and automated external defibrillator (AED) use with personal training manikins, or the conventional CPR group, which underwent a 180-minute training program with chest compressions, Rescue Breathing, and AED use. Participants' resuscitation skills were evaluated 6 months and 1 year after the training. The primary outcome measure was the proportion of appropriate chest compressions 1 year after the training. Results A total of 146 persons were enrolled, and 63 (87.5%) in the compression-only CPR group and 56 (75.7%) in the conventional CPR group completed the 1-year evaluation. The compression-only CPR group was superior to the conventional CPR group regarding the proportion of appropriate chest compression (mean ± SD = 59.8% ± 40.0% vs. 46.3% ± 28.6%; p = 0.036) and the number of appropriate chest compressions (mean ± SD = 119.5 ± 80.0 vs. 77.2 ± 47.8; p = 0.001). Time without chest compression in the compression-only CPR group was significantly shorter than that in the conventional CPR group (mean ± SD = 11.8 ± 21.1 seconds vs. 52.9 ± 14.9 seconds; p < 0.001). Conclusions The shortened compression-only CPR training program appears to help the general public retain CPR skills better than the conventional CPR training program. Resumen Objetivos No esta claro a cuanto tiempo se puede reducir un programa de formacion en resucitacion cardiopulmonar (RCP) sin afectar a su efectividad. El objetivo fue comparar las habilidades de RCP a los 6 meses y un ano tras la formacion entre una formacion de RCP abreviada de solo compresion toracica y una formacion en RCP convencional. Metodologia Los participantes se asignaron de forma aleatoria bien al grupo RCP de solo comprension que llevo a cabo un programa de formacion de 45 minutos consistente en las compresiones toracicas y a uso de desfibrilador externo automatico con maniqui de formacion personal; o bien el grupo de RCP convencional que llevo a cabo un programa de formacion de 180 minutos con la compresion toracica, la recuperacion de la respiracion y el uso de desfibrilador externo automatico. Las habilidades de resucitacion de los participantes se evaluaron a los 6 meses y al ano tras la formacion. La variable de resultado principal fue la proporcion de compresiones toracicas al ano de haber realizado la formacion. Resultados Se incluyeron 146 personas, de las cuales 63 (87,5%) en el grupo de RCP solo compresion y 56 (75,7%) en el grupo de RCP convencional completaron la evaluacion al ano. El grupo de RCP con solo compresion fue superior al grupo RCP convencional en relacion a la proporcion de compresiones toracicas apropiadas (59,8% [DE ± 40,0%] vs. 46,3% [DE ± 28,6%] p = 0,036), y al numero de compresiones toracicas apropiadas (119,5 [DE ± 80,0] vs. 77,2 [DE ± 47.8] p = 0.001). El tiempo sin compresion toracica en el grupo RCP con solo compresion (11,8 segundos [DE ± 21,1 segundos]) fue significativamente mas corto que el del grupo RCP convencional (52,9 segundos [DE ± 14.9 segundos], p < 0,001). Conclusiones El programa de formacion abreviado de solo compresion podria ayudar al publico general a retener las habilidades en RCP mejor que el programa de formacion RCP convencional.
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chest compression only cardiopulmonary resuscitation for out of hospital cardiac arrest with public access defibrillation a nationwide cohort study
Circulation, 2012Co-Authors: Taku Iwami, Tetsuhisa Kitamura, Takashi Kawamura, Ken Nagao, Hideharu Tanaka, Hideo Mitamura, Morimasa Takayama, Yoshihiko Seino, Hiroshi Nonogi, Naohiro YonemotoAbstract:Background—It remains unclear which is more effective to increase survival after out-of-hospital cardiac arrest in those with public-access defibrillation, bystander-initiated chest compression–only cardiopulmonary resuscitation (CPR) or conventional CPR with Rescue Breathing. Methods and Results—A nationwide, prospective, population-based observational study covering the whole population of Japan and involving consecutive out-of-hospital cardiac arrest patients with resuscitation attempts has been conducted since 2005. We enrolled all out-of-hospital cardiac arrests of presumed cardiac origin that were witnessed and received shocks with public-access automated external defibrillation (AEDs) by bystanders from January 1, 2005, to December 31, 2009. The main outcome measure was neurologically favorable 1-month survival. We compared outcomes by type of bystander-initiated CPR (chest compression–only CPR and conventional CPR with compressions and Rescue Breathing). Multivariable logistic regression was used to assess the relationship between the type of CPR and a better neurological outcome. During the 5 years, 1376 bystander-witnessed out-of-hospital cardiac arrests of cardiac origin in individuals who received CPR and shocks with public-access AEDs by bystanders were registered. Among them, 506 (36.8%) received chest compression–only CPR and 870 (63.2%) received conventional CPR. The chest compression– only CPR group (40.7%, 206 of 506) had a significantly higher rate of 1-month survival with favorable neurological outcome than the conventional CPR group (32.9%, 286 of 870; adjusted odds ratio, 1.33; 95% confidence interval, 1.03–1.70). Conclusions—Compression-only CPR is more effective than conventional CPR for patients in whom out-of-hospital cardiac arrest is witnessed and shocked with public-access defibrillation. Compression-only CPR is the most likely scenario in which lay Rescuers can witness a sudden collapse and use public-access AEDs. (Circulation. 2012;126:2844-2851.)
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Response to Letters Regarding Article, “Bystander-Initiated Rescue Breathing for Out-of-Hospital Cardiac Arrests of Noncardiac Origin”
Circulation, 2011Co-Authors: Tetsuhisa Kitamura, Taku Iwami, Takashi Kawamura, Ken Nagao, Hideharu Tanaka, Atsushi HiraideAbstract:We thank Dr Rai, Dr Arrich, and their colleagues for their relevant comments on our article.1 As Rai and colleagues pointed out, the recent randomized, controlled trial2 of dispatcher instructions to bystanders for performing cardiopulmonary resuscitation (CPR) failed to show statistical differences between chest compression-only and conventional CPR with Rescue Breathing in its subgroup analysis: the good neurological outcome after out-of-hospital cardiac arrests (OHCAs) of noncardiac origin was 6.9% (13/188) in the conventional CPR group and 4.4% (9/204) in the compression-only CPR group ( P =0.28). This might be due to its small sample size, and the results are consistent with ours. Since survival after OHCAs of noncardiac origin is generally low regardless of type of CPR, a large sample size is needed to address this issue, and our study …
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time dependent effectiveness of chest compression only and conventional cardiopulmonary resuscitation for out of hospital cardiac arrest of cardiac origin
Resuscitation, 2011Co-Authors: Tetsuhisa Kitamura, Taku Iwami, Robert A Berg, Takashi Kawamura, Ken Nagao, Hideharu Tanaka, Atsushi HiraideAbstract:Abstract Background Little is known about the effect of the type of bystander-initiated cardiopulmonary resuscitation (CPR) for prolonged out-of-hospital cardiac arrest (OHCA). Objectives To evaluate the time-dependent effectiveness of chest compression-only and conventional CPR with Rescue Breathing for witnessed adult OHCA of cardiac origin. Methods A nationwide, prospective, population-based, observational study of the whole population of Japan included consecutive OHCA patients with emergency responder resuscitation attempts from 1 January 2005 to 31 December 2007. Multiple logistic regression analysis was performed to assess the contribution of the bystander-initiated CPR technique to favourable neurological outcomes. Results Among 55014 bystander-witnessed OHCA of cardiac origin, 12165 (22.1%) received chest compression-only CPR and 10851 (19.7%) received conventional CPR. For short-duration OHCA (0–15min after collapse), compression-only CPR had a higher rate of survival with favourable neurological outcome than no CPR (6.4% vs. 3.8%; adjusted odds ratio (OR), 1.55; 95% confidence interval (CI), 1.38–1.74), and conventional CPR showed similar effectiveness (7.1% vs. 3.8%; adjusted OR, 1.78; 95% CI, 1.58–2.01). For the long-duration arrests (>15min), conventional CPR showed a significantly higher rate of survival with favourable neurological outcome than both no CPR (2.0% vs. 0.7%; adjusted OR, 1.93; 95% CI, 1.27–2.93) and compression-only CPR (2.0% vs. 1.3%; adjusted OR, 1.56; 95% CI, 1.02–2.44). Conclusions For prolonged OHCA of cardiac origin, conventional CPR with Rescue Breathing provided incremental benefit compared with either no CPR or compression-only CPR, but the absolute survival was low regardless of type of CPR.
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Response to Letters Regarding Article, “Bystander-Initiated Rescue Breathing for Out-of-Hospital Cardiac Arrests of Noncardiac Origin”
Circulation, 2011Co-Authors: Tetsuhisa Kitamura, Taku Iwami, Takashi Kawamura, Ken Nagao, Hideharu Tanaka, Atsushi HiraideAbstract:We thank Dr Rai, Dr Arrich, and their colleagues for their relevant comments on our article.1 As Rai and colleagues pointed out, the recent randomized, controlled trial2 of dispatcher instructions to bystanders for performing cardiopulmonary resuscitation (CPR) failed to show statistical differences between chest compression-only and conventional CPR with Rescue Breathing in its subgroup analysis: the good neurological outcome after out-of-hospital cardiac arrests (OHCAs) of noncardiac origin was 6.9% (13/188) in the conventional CPR group and 4.4% (9/204) in the compression-only CPR group ( P =0.28). This might be due to its small sample size, and the results are consistent with ours. Since survival after OHCAs of noncardiac origin is generally low regardless of type of CPR, a large sample size is needed to address this issue, and our study …
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time dependent effectiveness of chest compression only and conventional cardiopulmonary resuscitation for out of hospital cardiac arrest of cardiac origin
Resuscitation, 2011Co-Authors: Tetsuhisa Kitamura, Taku Iwami, Robert A Berg, Takashi Kawamura, Ken Nagao, Hideharu Tanaka, Atsushi HiraideAbstract:Abstract Background Little is known about the effect of the type of bystander-initiated cardiopulmonary resuscitation (CPR) for prolonged out-of-hospital cardiac arrest (OHCA). Objectives To evaluate the time-dependent effectiveness of chest compression-only and conventional CPR with Rescue Breathing for witnessed adult OHCA of cardiac origin. Methods A nationwide, prospective, population-based, observational study of the whole population of Japan included consecutive OHCA patients with emergency responder resuscitation attempts from 1 January 2005 to 31 December 2007. Multiple logistic regression analysis was performed to assess the contribution of the bystander-initiated CPR technique to favourable neurological outcomes. Results Among 55014 bystander-witnessed OHCA of cardiac origin, 12165 (22.1%) received chest compression-only CPR and 10851 (19.7%) received conventional CPR. For short-duration OHCA (0–15min after collapse), compression-only CPR had a higher rate of survival with favourable neurological outcome than no CPR (6.4% vs. 3.8%; adjusted odds ratio (OR), 1.55; 95% confidence interval (CI), 1.38–1.74), and conventional CPR showed similar effectiveness (7.1% vs. 3.8%; adjusted OR, 1.78; 95% CI, 1.58–2.01). For the long-duration arrests (>15min), conventional CPR showed a significantly higher rate of survival with favourable neurological outcome than both no CPR (2.0% vs. 0.7%; adjusted OR, 1.93; 95% CI, 1.27–2.93) and compression-only CPR (2.0% vs. 1.3%; adjusted OR, 1.56; 95% CI, 1.02–2.44). Conclusions For prolonged OHCA of cardiac origin, conventional CPR with Rescue Breathing provided incremental benefit compared with either no CPR or compression-only CPR, but the absolute survival was low regardless of type of CPR.
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bystander initiated Rescue Breathing for out of hospital cardiac arrests of noncardiac origin
Circulation, 2010Co-Authors: Tetsuhisa Kitamura, Taku Iwami, Takashi Kawamura, Ken Nagao, Hideharu Tanaka, Atsushi HiraideAbstract:Background— Although chest compression-only cardiopulmonary resuscitation (CPR) is effective for adult out-of-hospital cardiac arrest (OHCA) of cardiac origin, it remains uncertain whether bystander-initiated Rescue Breathing has an incremental benefit for OHCA of noncardiac origin. Methods and Results— A nationwide, prospective, population-based, observational study covering the whole population of Japan and involving consecutive OHCA patients with emergency responder resuscitation attempts was conducted from January 2005 through December 2007. The primary outcome was neurologically intact 1-month survival. Multiple logistic regression analysis was used to assess the contribution of bystander-initiated CPR to better neurological outcomes. Among a total of 43 246 bystander-witnessed OHCAs of noncardiac origin, 8878 (20.5%) received chest compression-only CPR, and 7474 (17.3%) received conventional CPR with Rescue Breathing. The conventional CPR group (1.8%) had a higher rate of better neurological outcome...
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conventional and chest compression only cardiopulmonary resuscitation by bystanders for children who have out of hospital cardiac arrests a prospective nationwide population based cohort study
The Lancet, 2010Co-Authors: Tetsuhisa Kitamura, Taku Iwami, Takashi Kawamura, Hideharu Tanaka, Robe A Erg, Ke Nagao, Vinay M Nadkarni, Atsushi HiraideAbstract:Summary Background The American Heart Association recommends cardiopulmonary resuscitation (CPR) by bystanders with chest compression only for adults who have cardiac arrests, but not for children. We assessed the effect of CPR (conventional with Rescue Breathing or chest compression only) by bystanders on outcomes after out-of-hospital cardiac arrests in children. Methods In a nationwide, prospective, population-based, observational study, we enrolled 5170 children aged 17 years and younger who had an out-of-hospital cardiac arrest from Jan 1, 2005, to Dec 31, 2007. Data collected included age, cause, and presence and type of CPR by bystander. The primary endpoint was favourable neurological outcome 1 month after an out-of-hospital cardiac arrest, defined as Glasgow-Pittsburgh cerebral performance category 1 or 2. Findings 3675 (71%) children had arrests of non-cardiac causes and 1495 (29%) cardiac causes. 1551 (30%) received conventional CPR and 888 (17%) compression-only CPR. Data for type of CPR by bystander were not available for 12 children. Children who were given CPR by a bystander had a significantly higher rate of favourable neurological outcome than did those not given CPR (4·5% [110/2439] vs 1·9% [53/2719]; adjusted odds ratio [OR] 2·59, 95% CI 1·81–3·71). In children aged 1–17 years who had arrests of non-cardiac causes, favourable neurological outcome was more common after bystander CPR than no CPR (5·1% [51/1004] vs 1·5% [20/1293]; OR 4·17, 2·37–7·32). However, conventional CPR produced more favourable neurological outcome than did compression-only CPR (7·2% [45/624] vs 1·6% [six of 380]; OR 5·54, 2·52–16·99). In children aged 1–17 years who had arrests of cardiac causes, favourable neurological outcome was more common after bystander CPR than no CPR (9·5% [42/440] vs 4·1% [14/339]; OR 2·21, 1·08–4·54), and did not differ between conventional and compression-only CPR (9·9% [28/282] vs 8·9% [14/158]; OR 1·20, 0·55–2·66). In infants (aged Interpretation For children who have out-of-hospital cardiac arrests from non-cardiac causes, conventional CPR (with Rescue Breathing) by bystander is the preferable approach to resuscitation. For arrests of cardiac causes, either conventional or compression-only CPR is similarly effective. Funding Fire and Disaster Management Agency and the Ministry of Education, Culture, Sports, Science and Technology (Japan).
