title: Bystander cardiopulmonary resuscitation. Is ventilation necessary?
abstract: BACKGROUND
  Prompt initiation of bystander cardiopulmonary resuscitation (CPR) improves survival. Basic life support with mouth-to-mouth ventilation and chest compressions is intimidating, difficult to remember, and difficult to perform. Chest compressions alone can be easily taught, easily remembered, easily performed, adequately taught by dispatcher-delivered telephone instruction, and more readily accepted by the public. The principal objective of this study was to evaluate the need for ventilation during CPR in a clinically relevant swine model of prehospital witnessed cardiac arrest.
  
  
  RESULTS
  Thirty seconds after ventricular fibrillation, swine were randomly assigned to 12 minutes of chest compressions plus mechanical ventilation (group A), chest compressions only (group B), or no CPR (group C). Standard advanced cardiac life support was then provided. Animals successfully resuscitated were supported for 2 hours in an intensive care setting, and then observed for 24 hours. All 16 swine in groups A and B were successfully resuscitated and neurologically normal at 24 hours, whereas only 2 of 8 group C animals survived for 24 hours (P < .001, Fisher's exact test). One of the 2 group C survivors was comatose and unresponsive.
  
  
  CONCLUSIONS
  In this swine model of witnessed prehospital cardiac arrest, the survival and neurological outcome data establish that prompt initiation of chest compressions alone appears to be as effective as chest compressions plus ventilation and that both techniques of bystander CPR markedly improve outcome compared with no bystander CPR.
authors.affiliation: Department of Pediatrics, College of Medicine, University of Arizona, Tucson.
authors.forename: R A
authors.initials: RA
authors.lastname: Berg
authors.forename: K B
authors.initials: KB
authors.lastname: Kern
authors.forename: A B
authors.initials: AB
authors.lastname: Sanders
authors.forename: C W
authors.initials: CW
authors.lastname: Otto
authors.forename: R W
authors.initials: RW
authors.lastname: Hilwig
authors.forename: G A
authors.initials: GA
authors.lastname: Ewy
mesh_terms: D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002490:Central Nervous System / Q000502:physiology; D003422:Critical Care; D004195:Disease Models, Animal; D004554:Electric Countershock; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy*; D006801:Humans; D012121:Respiration, Artificial; D013552:Swine; D013997:Time Factors; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000150:complications