¿RCP Standard o Compresiones torácicas solamente?

El valor de las compresiones cardíacas durante el RCP

 

Desde que en 1960  Kouwenhoven,  Jude y Knickerbocker propusieron en la revista JAMA los masajes cardíacos para mantener la circulación de los pacientes en paro cardíaco, ésto se ha adoptado en forma generalizada. Poco tiempo después la ventilación externa se sumó a las compresiones para dar soporte vital básico. Desde entonces hubo muy pocos cambios en la realización de RCP.

 

En los últimos años trabajos con animales (cerdos) han aportado algunos conceptos: A) la interrupción de las compresiones torácicas resulta en disminución de la perfusión coronaria durante la RCP y B) el aumento de la frecuencia de las ventilaciones con presión positiva disminuye la tasa de sobrevida (por la interrupción de las compresiones y por la disminución del retorno venoso provocado por el aumento de la presión intratorácica)

Estos datos hicieron hipotetizar que la realización de compresiones solas mejorarían la sobrevida de los pacientes con ataques cardíacos.

   

En 2 estudios recientemente publicados en NEJM (29 de Julio 2010 http://www.nejm.org/) se ha valorizado el papel de las compresiones cardíacas durante las maniobras de RCP  por sobre las ventilaciones de rescate.  Ambos estudios (uno sueco y otro multicéntrico USA/UK) demostraron que no hay diferencias en la sobrevida entre los pacientes que recibieron RCP Standard (con ventilaciones de rescate) y aquellos que recibieron sólo compresiones torácicas.

 

 

 

Compression-Only CPR or Standard CPR  in Out-of-Hospital Cardiac Arrest

Leif Svensson, M.D., Ph.D., Katarina Bohm, R.N., Ph.D., Maaret Castrèn, M.D., Ph.D., Hans Pettersson, Ph.D., Lars Engerström, M.D.,  Johan Herlitz, M.D., Ph.D., and Mårten Rosenqvist, M.D., Ph.D.

   

BACKGROUND

Emergency medical dispatchers give instructions on how to perform cardiopulmonary

resuscitation (CPR) over the telephone to callers requesting help for a patient

with suspected cardiac arrest, before the arrival of emergency medical services (EMS)

personnel. A previous study indicated that instructions to perform CPR consisting

of only chest compression result in a treatment efficacy that is similar or even superior

to that associated with instructions given to perform standard CPR, which

consists of both compression and ventilation. That study, however, was not powered

to assess a possible difference in survival. The aim of this prospective, randomized

study was to evaluate the possible superiority of compression-only CPR over

standard CPR with respect to survival.

METHODS

Patients with suspected, witnessed, out-of-hospital cardiac arrest were randomly assigned

to undergo either compression-only CPR or standard CPR. The primary end

point was 30-day survival.

RESULTS

Data for the primary analysis were collected from February 2005 through January

2009 for a total of 1276 patients. Of these, 620 patients had been assigned to receive

compression-only CPR and 656 patients had been assigned to receive standard CPR.

The rate of 30-day survival was similar in the two groups: 8.7% (54 of 620 patients)

in the group receiving compression-only CPR and 7.0% (46 of 656 patients) in the

group receiving standard CPR (absolute difference for compression-only vs. standard

CPR, 1.7 percentage points; 95% confidence interval, −1.2 to 4.6; P = 0.29).

CONCLUSIONS

This prospective, randomized study showed no significant difference with respect

to survival at 30 days between instructions given by an emergency medical dispatcher,

before the arrival of EMS personnel, for compression-only CPR and instructions

for standard CPR in patients with suspected, witnessed, out-of-hospital cardiac arrest.

(Funded by the Swedish Heart–Lung Foundation and others; Karolinska Clinical

Trial Registration number, CT20080012.)

 

 

 

CPR with Chest Compression Alone  or with Rescue Breathing

Thomas D. Rea, M.D., Carol Fahrenbruch, M.S.P.H., Linda Culley, B.A.,  Rachael T. Donohoe, Ph.D., Cindy Hambly, E.M.T., Jennifer Innes, B.A.,  Megan Bloomingdale, E.M.T., Cleo Subido, Steven Romines, M.S.P.H.,  and Mickey S. Eisenberg, M.D., Ph.D.

   

Background

The role of rescue breathing in cardiopulmonary resuscitation (CPR) performed by

a layperson is uncertain. We hypothesized that the dispatcher instructions to bystanders

to provide chest compression alone would result in improved survival as

compared with instructions to provide chest compression plus rescue breathing.

Methods

We conducted a multicenter, randomized trial of dispatcher instructions to bystanders

for performing CPR. The patients were persons 18 years of age or older with out-ofhospital

cardiac arrest for whom dispatchers initiated CPR instruction to bystanders.

Patients were randomly assigned to receive chest compression alone or chest compression

plus rescue breathing. The primary outcome was survival to hospital discharge.

Secondary outcomes included a favorable neurologic outcome at discharge.

Results

Of the 1941 patients who met the inclusion criteria, 981 were randomly assigned to

receive chest compression alone and 960 to receive chest compression plus rescue

breathing. We observed no significant difference between the two groups in the

proportion of patients who survived to hospital discharge (12.5% with chest compression

alone and 11.0% with chest compression plus rescue breathing, P = 0.31)

or in the proportion who survived with a favorable neurologic outcome in the two

sites that assessed this secondary outcome (14.4% and 11.5%, respectively; P = 0.13).

Prespecified subgroup analyses showed a trend toward a higher proportion of patients

surviving to hospital discharge with chest compression alone as compared

with chest compression plus rescue breathing for patients with a cardiac cause of

arrest (15.5% vs. 12.3%, P = 0.09) and for those with shockable rhythms (31.9% vs.

25.7%, P = 0.09).

Conclusions

Dispatcher instruction consisting of chest compression alone did not increase the

survival rate overall, although there was a trend toward better outcomes in key clinical

subgroups. The results support a strategy for CPR performed by laypersons that

emphasizes chest compression and minimizes the role of rescue breathing. (Funded

in part by the Laerdal Foundation for Acute Medicine and the Medic One Foundation;

ClinicalTrials.gov number, NCT00219687.)