title: Compression-only cardiopulmonary resuscitation in improving bystanders' cardiopulmonary resuscitation performance: a literature review.
abstract: BACKGROUND
  Compression-only cardiopulmonary resuscitation (CPR) has been advocated as a preferable approach for bystanders in an out-of-hospital cardiac arrest (OHCA) event as it has been associated with an increased chance of survival. The elimination of mouth-to-mouth ventilation also addresses some of the barriers to performing CPR. The aim of this study is to undertake a literature review investigating the effectiveness of compression-only CPR in improving rescuers' CPR performance when compared with standard CPR.
  
  
  METHODS
  A literature search was conducted in the following databases: Cumulative Index to Nursing and Allied Health Literature, Science Direct, Scopus and PubMed from January 2003 to January 2014, to include research studies that compared compression-only CPR with standard CPR on participants above the age of 21, and reported quality of CPR performance as the primary outcome.
  
  
  RESULTS
  Of the 3004 articles retrieved, 16 met the inclusion criteria. The reviewed studies revealed that compression-only CPR requires a shorter time to initiate CPR and delivers a higher number of total compressions. The depth of compressions in compression-only CPR performed may be shallower than that of standard CPR due to greater rescuer fatigue. It therefore remains inconclusive if compression-only CPR can deliver a higher number of adequate compressions over extended periods of time. It is also unclear if simplified CPR can improve skill retention level in the long run.
  
  
  CONCLUSIONS
  More studies are needed to determine whether compression-only CPR can indeed help improve rescuers' CPR performance. Future research efforts, together with resuscitation policy and practice implications, are needed to further improve rescuers' CPR performance with the ultimate goal to enhance OHCA survival rates.
authors.affiliation: National Heart Centre, 5 Hospital Drive, Singapore.
authors.forename: Rachel Jia
authors.initials: RJ
authors.lastname: Min Ko
authors.affiliation: Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Singapore.
authors.forename: Vivien Xi
authors.initials: VX
authors.lastname: Wu
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore.
authors.forename: Swee Han
authors.initials: SH
authors.lastname: Lim
authors.affiliation: Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Singapore.
authors.forename: Wilson Wai
authors.initials: WW
authors.lastname: San Tam
authors.affiliation: Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Singapore.
authors.forename: Sok Ying
authors.initials: SY
authors.lastname: Liaw
mesh_terms: D000572:American Heart Association; D006336:Heart Massage / Q000592:standards*; D006801:Humans; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D017410:Practice Guidelines as Topic; D016019:Survival Analysis; D014481:United States
keywords: cardiac arrest; first responders; prehospital care; resuscitation, effectiveness