Cardiology AdvisorBystander sCPR and Chest Compression-Only CPR Yield Similar Outcomes in OHCA

⚠️ Small Study / Early Comparative Evidence

Bystander CPR initiation rates remain a key determinant of OHCA survival. Whether standard CPR with ventilation or chest compression-only CPR produces superior outcomes has direct implications for public training priorities and dispatcher guidance. This meta-analysis pooled 13 observational cohorts and 5 RCTs across multiple countries, totaling 232,655 adult OHCA cases.

Clinical Considerations

• No statistically significant differences were found between sCPR and compression-only CPR for prehospital ROSC, survival to admission, favorable neurologic outcomes, or survival to discharge
• Sensitivity analyses suggested lower 24-hour survival with sCPR (OR 0.87-0.90) and higher 1-month mortality after compression-only CPR (OR 1.32); these conflicting signals warrant cautious interpretation
• Observational data dominate the pooled sample, introducing selection bias and confounding around bystander training quality and CPR performance consistency
• RCT data were limited to five trials conducted in Sweden, France, and the US, limiting generalizability across healthcare systems and bystander training environments
• Authors note compression-only CPR may increase bystander willingness to act and is more readily taught, learned, and dispatcher-assisted — practical considerations not captured in outcome data

Practice Applications

• Recognize that current evidence does not establish superiority of either approach for adult OHCA; both remain clinically acceptable
• Interpret sensitivity analysis findings (early and late mortality signals) as hypothesis-generating rather than practice-changing
• Consider compression-only CPR as a pragmatically sound option for public training programs given equivalent outcomes and likely higher initiation rates
• Monitor for updated RCT evidence; the observational weight of this meta-analysis limits definitive conclusions on ventilation benefit