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The article assesses the effects of cardiopulmonary resuscitation with chest compression only and not mouth-to-mouth ventilation done by bystanders on people who had cardiac arrest. It is remarked that mouth-to-mouth ventilation is a barrier to bystanders who perform cardiopulmonary resuscitation. The authors conducted an observational study of patients who had cardiac arrest and assessed the technique of resuscitation done by the bystanders. The authors found that cardiac-only resuscitation by bystanders is a better approach to resuscitation of patients with out-of-hospital cardiac arrest, particularly those patients with apnea, shockable rhythm, or untreated arrest.

A response by Ken Nagao for the SOS-KANTO Committee to a letter to the editor about the article "Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): An observational study" in the March 17, 2007 issue is presented.

Background: More than 80% of public-access defibrillation attempts do not result in sustained return of spontaneous circulation in patients who have had an out-of-hospital cardiac arrest (OHCA) and a shockable heart rhythm before arrival of emergency medical service (EMS) personnel. Neurological and survival outcomes in such patients have not been evaluated. We aimed to assess the neurological status and survival outcomes in such patients.Methods: This is a retropective analysis of a cohort study from a prospective, nationwide, population-based registry of 1 299 784 patients who had an OHCA event between Jan 1, 2005, and Dec 31, 2015 in Japan. The primary outcome was favourable neurological outcome (Cerebral Performance Category of 1 or 2) at 30 days after the OHCA and the secondary outcome was survival at 30 days following the OHCA. This study is registered with the University Hospital Medical Information Network Clinical Trials Registry, UMIN000009918.Findings: We identified 28 019 patients with bystander-witnessed OHCA and shockable heart rhythm who had received CPR from a bystander. Of these, 2242 (8·0%) patients did not achieve return of spontaneous circulation with CPR plus public-access defibrillation, and 25 087 (89·5%) patients did not achieve return of spontaneous circulation with CPR alone before EMS arrival. The proportion of patients with a favourable neurological outcome was significantly higher in those who received public-access defibrillation than those who did not (845 [37·7%] vs 5676 [22·6%]; adjusted odds ratio [OR] after propensity score-matching, 1·45 [95% CI 1·24-1·69], p<0·0001). The proportion of patients who survived at 30 days after the OHCA was also significantly higher in those who received public-access defibrillation than those who did not (987 [44·0%] vs 7976 [31·8%]; adjusted OR after propensity score-matching, 1·31 [95% CI 1·13-1·52], p<0·0001).Interpretation: Our findings support the benefits of public-access defibrillation and greater accessibility and availability of automated external defibrillators in the community.Funding: None. [ABSTRACT FROM AUTHOR]

The prognosis after out-of-hospital cardiac arrest (OHCA) has improved in the past few decades because of advances in interventions used outside and in hospital. About half of patients who have OHCA with initial ventricular tachycardia or ventricular fibrillation and who are admitted to hospital in coma after return of spontaneous circulation will survive to discharge with a reasonable neurological status. In this Series paper we discuss in-hospital management of patients with post-cardiac-arrest syndrome. In most patients, the most important in-hospital interventions other than routine intensive care are continuous active treatment (in non-comatose and comatose patients and including circulatory support in selected patients), cooling of core temperature to 32-36°C by targeted temperature management for at least 24 h, immediate coronary angiography with or without percutaneous coronary intervention, and delay of final prognosis until at least 72 h after OHCA. Prognosis should be based on clinical observations and multimodal testing, with focus on no residual sedation. [ABSTRACT FROM AUTHOR]

The article discusses a study which investigated the effect of cardiopulmonary resuscitation (CPR) by bystanders on outcomes after out-of-hospital cardiac arrest in children. The prospective, population-based, observational study involved 5,170 children aged 17 years and younger. Among the data that were collected were data for sex, age, cause, and first documented cardiac rhythm. It was concluded that either conventional or compression-only CPR is similarly effective for arrests of cardiac causes.