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Response to Letter Regarding Article “Effectiveness of Bystander-Initiated Cardiac-Only Resuscitation for Patients With Out-of-Hospital Cardiac Arrest”

2008; Lippincott Williams & Wilkins; Volume: 117; Issue: 25 Linguagem: Inglês

10.1161/circulationaha.108.773473

1524-4539

Taku Iwami, Takashi Kawamura, Atsushi Hiraide, Robert A. Berg, Yasuyuki Hayashi, Tatsuya Nishiuchi, Kentaro Kajino, Hisashi Sugimoto, Naohiro Yonemoto, Hidekazu Yukioka, Hiroyuki Kakuchi, Kazuhiro Sase, Hiroyuki Yokoyama, Hiroshi Nonogi,

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HomeCirculationVol. 117, No. 25Response to Letter Regarding Article "Effectiveness of Bystander-Initiated Cardiac-Only Resuscitation for Patients With Out-of-Hospital Cardiac Arrest" Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBResponse to Letter Regarding Article "Effectiveness of Bystander-Initiated Cardiac-Only Resuscitation for Patients With Out-of-Hospital Cardiac Arrest" Taku Iwami, MD, PhD and Takashi Kawamura, MD, PhD Atsushi Hiraide, MD, PhD Robert A. Berg, MD Yasuyuki Hayashi, MD, PhD Tatsuya Nishiuchi, MD Kentaro Kajino, MD and Hisashi Sugimoto, MD, PhD Naohiro Yonemoto, MPH Hidekazu Yukioka, MD, PhD Hiroyuki Kakuchi, MD, PhD Kazuhiro Sase, MD, PhD Hiroyuki Yokoyama, MD, PhD and Hiroshi Nonogi, MD, PhD Taku IwamiTaku Iwami Kyoto University Health Service, Kyoto, Japan and Takashi KawamuraTakashi Kawamura Kyoto University Health Service, Kyoto, Japan Atsushi HiraideAtsushi Hiraide Center for Medical Education, Kyoto University Graduate School of Medicine, Kyoto, Japan Robert A. BergRobert A. Berg Sarver Heart Center, The University of Arizona College of Medicine, Tucson, Ariz Yasuyuki HayashiYasuyuki Hayashi Senri Critical Care Medical Center, Osaka Saiseikai Senri Hospital, Suita, Japan Tatsuya NishiuchiTatsuya Nishiuchi Osaka Prefectural Senshu Critical Care Medical Center, Izumisano, Japan Kentaro KajinoKentaro Kajino Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan and Hisashi SugimotoHisashi Sugimoto Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan Naohiro YonemotoNaohiro Yonemoto Department of Biostatistics, Kyoto University School of Public Health, Kyoto, Japan Hidekazu YukiokaHidekazu Yukioka Yukioka Hospital, Osaka, Japan Hiroyuki KakuchiHiroyuki Kakuchi Department of Cardiology, Tokai University Hachioji Hospital, Hachioji, Japan Kazuhiro SaseKazuhiro Sase Department of Clinical Pharmacology, Juntendo University Medical School, Tokyo, Japan Hiroyuki YokoyamaHiroyuki Yokoyama Division of Cardiology, National Cardiovascular Center, Suita, Japan and Hiroshi NonogiHiroshi Nonogi Division of Cardiology, National Cardiovascular Center, Suita, Japan Originally published24 Jun 2008https://doi.org/10.1161/CIRCULATIONAHA.108.773473Circulation. 2008;117:e509We thank Drs Lederer and Wiedermann for their interest and comments on bystander-initiated cardiac-only resuscitation. Although cardiac-only resuscitation is not a novel concept, our large-scale population-based study and other recent investigations provide important clinical evidence that bystander-initiated cardiac-only resuscitation is at least as effective as bystander-initiated chest compressions plus rescue breathing.1 These new data in different settings with different systems indicate that these findings are robust and generalizable.Reluctance for rescue breathing is not the only factor affecting the willingness of bystanders to initiate CPR. Nevertheless, a multitude of data indicates that rescue breathing is a major obstacle for the provision of bystander CPR.2 In addition, ample data demonstrate that simpler techniques, such as cardiac-only resuscitation, are easier to teach, remember, and perform.2 Although continuous chest compressions may cause rescuer fatigue and result in CPR deterioration over time, interruptions of chest compressions for rescue breaths is a more substantial problem for providing adequate circulation.3,4,5 Lederer and Wiedermann propose studying modified ratios of rescue breaths to compressions; however, providing any rescue breaths is an additional barrier to learning and performing CPR.Finally, we agree with Lederer and Wiedermann on the need for bystander CPR advocacy and public awareness campaigns. We also believe that recommendations are not enough; programs must be implemented and outcomes must be measured to determine whether the programs save lives. In Osaka, we have started to teach people the simplified CPR technique of cardiac-only resuscitation, and we are evaluating whether this new program will increase the frequency of bystander-initiated CPR and will result in higher rates of long-term survival.DisclosuresNone. References 1 SOS-KANTO. Cardiopulmonary resuscitation by bystanders with chest compression only: an observational study. Lancet. 2007; 369: 920–926.CrossrefMedlineGoogle Scholar2 Becker LB, Berg RA, Pepe PE, Idris AH, Aufderheide TP, Barnes TA, Stratton SJ, Chandra NC. A reappraisal of mouth-to-mouth ventilation during bystander-initiated cardiopulmonary resuscitation. Circulation. 1997; 96: 2102–2112.CrossrefMedlineGoogle Scholar3 Heidenreich JW, Berg RA, Higdon TA, Ewy GA, Kern KB, Sanders AB. Rescuer fatigue: standard versus continuous chest-compression cardiopulmonary resuscitation. Acad Emerg Med. 2006; 13: 1020–1026.CrossrefMedlineGoogle Scholar4 Assar D, Chamberlain D, Colquhoun M, Donnelly P, Handley AJ, Leaves S, Kern KB. Randomised controlled trials of staged teaching for basic life support. 1. Skill acquisition at bronze stage. Resuscitation. 2000; 45: 7–15.CrossrefMedlineGoogle Scholar5 Heidenreich JW, Sanders AB, Higdon TA, Kern KB, Berg RA, Ewy GA. Uninterrupted chest compression CPR is easier to perform and remember than standard CPR. Resuscitation. 2004; 63: 123–130.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails June 24, 2008Vol 117, Issue 25 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.108.773473 Originally publishedJune 24, 2008 PDF download Advertisement SubjectsCardiopulmonary Resuscitation and Emergency Cardiac Care