It's supposed to be a foregone conclusion (right?), but one debate at AHA 2012 provided convincing arguments against chest compressions. This could be a major paradigm shift: To compress or not to compress?
The most provocative presentation at AHA 2012 (#AHA12) was presented by Dr. Gust Barty who made a convincing argument that we should at least study whether the use of chest compressions in cardiac arrests is better than prompt use of a defibrillator and no compression at all. He sighted data from Piacenza Italy where this practice is being used. Survival in this community is 34% at 1 year after cardiac arrest. This is in direct opposition to the current recommendations of AHA that chest compression should be done immediately and with minimal interruptions.
I summarize the major arguments Dr Barty makes in my blog.
At HRS12, this data was presented. Abstract says: Piacenza, Italy has recorded 2,730 OOH-CAs in 12 years. Mean age of was 73.6 +/- 14.8 years and men represented 59.5%. OOH-CA was treated by EMS in 2668 and by Progetto Vita in 62. The 12 year all cause survival rate is 4% when OOH-CA is treated by EMS and 34% when treated by PV, log rank p<0.001. Independent predictors of survival were age (p=0.008) and Progetto Vita intervention (p=0.034). Age was related to shorter survival by every year of age by 6% (95% CI: 1-10%). Progetto Vita was protective with HR = 0.62 (95% CI: 0.39-0.95). There were no differences in survival when adjusted for location of arrest, intervention time and the presence of a shockable rhythm at first ECG. Limitations of this study include the small numbers treated by Progetto Vita and non-randomized populations. Conclusions: Long-term survival is better for OOH-CA when only an AED is used, and CPR is avoided, compared to the traditional EMS response. It is time for a randomized trial of CPR vs. No-CPR.