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Iwami et al Compression-Only CPR <strong>for</strong> OHCA With PAD 2851Potts J, Sayre MR, Swor RA, Travers AH; American Heart AssociationEmergency Cardiovascular Care Committee; Council on Cardiopulmonary,Critical Care, Perioperative and <strong>Resuscitation</strong>. Emergency medicalservice dispatch cardiopulmonary resuscitation prearrival instructions toimprove survival from out-of-hospital cardiac arrest: a scientificstatement from <strong>the</strong> American Heart Association. <strong>Circulation</strong>. 2012;125:648–655.40. Koster RW, Bossaert LL, Nolan JP, Zideman D; Board of <strong>the</strong> European<strong>Resuscitation</strong> Council. Advisory statement of <strong>the</strong> European <strong>Resuscitation</strong>Council on Basic Life Support. http://www.erc.edu/index.php/docLibrary/en/viewDoc/775/3/. Accessed March 4, 2012.41. Hands-only TM CPR. American Heart Association. http://handsonlycpr.org/.Accessed March 4, 2012.42. Nitta M, Iwami T, Kitamura T, Nadkarni VM, Berg RA, Shimizu N, OhtaK, Nishiuchi T, Hayashi Y, Hiraide A, Tamai H, Kobayashi M, Morita H.Utstein Osaka Project. Age-specific differences in outcomes after out-ofhospitalcardiac arrests. Pediatrics. 2011;128:e812–e820.43. Atkins DL, Everson-Stewart S, Sears GK, Daya M, Osmond MH, WardenCR, Berg RA; <strong>Resuscitation</strong> Outcomes Consortium Investigators. Epidemiologyand outcomes from out-of-hospital cardiac arrest in children: <strong>the</strong><strong>Resuscitation</strong> Outcomes Consortium Epistry-Cardiac Arrest. <strong>Circulation</strong>.2009;119:1484–1491.44. Bardai A, Berdowski J, van der Werf C, Blom MT, Ceelen M, vanLangen IM, Tijssen JG, Wilde AA, Koster RW, Tan HL. Incidence,causes, and outcomes of out-of-hospital cardiac arrest in children: acomprehensive, prospective, population-based study in <strong>the</strong> Ne<strong>the</strong>rlands.J Am Coll Cardiol. 2011;57:1822–1828.CLINICAL PERSPECTIVEAlthough early cardiopulmonary resuscitation (CPR) and shocks with public-access automated external defibrillators(AEDs) are <strong>the</strong> keys to saving lives after sudden cardiac arrests, <strong>the</strong> proportion of bystander CPR remains low. Becausechest compression–only CPR (CCCPR) is easier to learn and per<strong>for</strong>m than conventional CPR, CCCPR would lead to anincrease in <strong>the</strong> number of individuals trained and increase CPR and AED use by bystanders. Recently, <strong>the</strong> effectivenessof CCCPR has become well accepted, but conventional CPR with rescue breathing is still <strong>the</strong> standard of CPR. However,some animal and clinical reports have suggested that <strong>the</strong> effectiveness of each type of bystander CPR is time dependentand that CCCPR may be more effective than conventional CPR in <strong>the</strong> early phase of sudden cardiac arrest. Among thosewith public-access defibrillation in whom defibrillation would be delivered fast and CPR would be needed only in <strong>the</strong> earlyphase after collapse, CCCPR can be more beneficial than conventional CPR. Based on this hypo<strong>the</strong>sis, our studydemonstrated that CCCPR is more effective than conventional CPR <strong>for</strong> individuals with witnessed OHCA who are shockedwith public-access AEDs through a large, prospective, population-based registry covering all of Japan where <strong>the</strong>public-access defibrillation program is successfully developed. We believe that CCCPR could be a standard by which layrescuers are likely to witness sudden collapse and use public-access AEDs. Because penetration and more frequent use ofpublic-access defibrillation remain a challenge <strong>for</strong> many areas, strategies and ef<strong>for</strong>ts to increase <strong>the</strong> number ofpublic-access AEDs and lay rescuers who can per<strong>for</strong>m chest compressions and use an AED are needed.Go to http://cme.ahajournals.org to take <strong>the</strong> CME quiz <strong>for</strong> this article.Downloaded from http://circ.ahajournals.org/ by guest on January 21, 2013
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