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Compression-only cardiopulmonary resuscitation in improving bystanders’ cardiopulmonary resuscitation performance: a literature review
  1. Rachel Jia Min Ko1,
  2. Vivien Xi Wu2,
  3. Swee Han Lim3,
  4. Wilson Wai San Tam2,
  5. Sok Ying Liaw2
  1. 1National Heart Centre, 5 Hospital Drive, Singapore
  2. 2Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Singapore
  3. 3Department of Emergency Medicine, Singapore General Hospital, Singapore
  1. Correspondence to Dr Sok Ying Liaw, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11 10 Medical Drive, Singapore 117597, Singapore; nurliaw{at}


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.

Findings 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.

  • resuscitation, effectiveness
  • cardiac arrest
  • first responders
  • prehospital care

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