Simplified cardiopulmonary resuscitation with chest compressions only compared to cardiopulmonary resuscitation with chest compressions and ventilations? A national randomized clinical survival trial

Research question: Is simplified cardiopulmonary resuscitation (CPR) using chest compressions only as good as CPR using both chest compressions and ventilations in out-of-hospital cardiac arrest (OHCA)?Background:OHCA affects 10 000 Swedish citizens yearly and only 10% survive. Bystander CPR is associated with a doubled chance of survival.

Historically, CPR has included both ventilation and chest compressions.

However, simplified CPR with chest compressions only (CO-CPR) has been associated with equal survival compared to standard CPR (S-CPR) in cases of OHCA were untrained rescuers have performed CPR. Whether CO-CPR is no worse than, or superior to S-CPR when performed by trained bystanders remains unclear.

In this prospective randomized controlled national trial, adult OHCA with trained bystanders present will be randomized at all dispatch centers in Sweden. Instructions will be given to perform either CO-CPR or S-CPR until ambulance arrival. Primary outcome is 30 days survival.Preliminary results: The study started Jan 2017.

Due to Covid-19 pandemic the study was put on hold in March 2020.

An independent data monitoring committee reviewed all data in 2022 and recommended to continue the trial without modifications. The study was restarted nationally in August 2022 and has recriuted 1600 out of 3260 patients.

Significance: This study could affect the way CPR is taught and performed worldwide, and might lead to a higher incidence of bystander-CPR and survival in OHCA.