Two CPR Strategies Fail to Improve Outcomes After Cardiac Arrest

The findings of these "extremely well-performed," high-level scientific inquiries show that it may be more useful to consider out-of-hospital cardiac arrest as a public health problem rather than as a disease process, Dr. Arthur B. Sanders said.

And "randomized, controlled trials may not be the best strategy for making progress in the management of public health problems." After all, the efficacy of closed-chest compression, mouth-to-mouth rescue breathing, layperson-administered CPR, and prehospital defibrillation by EMS "were all major clinical advances ... that were not subjected to randomized clinical trials," he noted.

An alternative strategy of making systemic changes in standard CPR protocols nearly tripled the survival rate after cardiac arrest in Arizona, and the same model achieved similar survival benefits when used in rural Wisconsin, Dr. Sanders said.

Dr. Sanders, M.D., is in the department of emergency medicine at the University of Arizona’s Sarver Heart Center, Tucson. He reported no financial conflicts of interest. These remarks were taken from his editorial accompanying the reports by Dr. Stiell and Dr. Aufderheide (N. Engl. J. Med. 2011;365:850-1).