The expert says these latest findings reiterate what the American Heart Foundation (AHA) advised in 2008 – that compression only CPR is recommended for bystanders who are not properly trained or who are not at ease with performing mouth-to-mouth on individuals who collapsed from sudden cardiac arrest (sudden, unexpected loss of heart function, breathing and consciousness). In the NEJM editorial, published on July 29th, Myron (Mike) Weisfeldt, M.D., a cardiologist, physician in chief at The Johns Hopkins Hospital and director of the Department of Medicine at Hopkins’ School of Medicine, says “less may be better” in CPR, calling the findings straightforward, practical and potentially life-saving.

The two studies looked at over 3,000 individuals (males and females) who needed CPR between 2004 and 2009. The researchers found that survival rates for patients who received just chest compressions from bystanders was similar to those who received both chest compressions and rescue breathing (mouth-to-mouth).

The bystanders in all cases were told by phone during a 911 call how to do CPR. One study showed survival rates after one month of 8.7 percent and 7 percent, respectively, while the other showed survival rates at time of hospital discharge of 12.5 percent and 11 percent. The researchers say the numbers were statistically the same.Weisfeldt, a past president of the AHA (1989-1990), said:

It is very important to understand that the patients in this study were adults and that for most children who suffer cardiac arrest, such as drowning victims, we must do rescue breathing.

He also notes that there are adults with breathing-related causes of sudden death where rescue breathing should be performed, including patients with sudden, acute heart failure, severe chronic lung disease, or acute asthma, and cardiac arrest. However, Weisfeldt says:

“For people who are not well-trained or who are looking for a simple way to help save a life, chest compressions only, at least until the emergency care unit arrives, can be life saving, even without rescue breathing.

According to Weisfeldt, these latest finding may lead to stronger national guidelines on how passers-by should perform CPS. He adds that an update is expected to be announced in November in Chicago at an AHA annual meeting. Guidelines will probably recommend a steady 100 chest compressions per minute with less emphasis on rescue breathing.Weisfeldt stresses that both latest studies and previous animal studies had revealed that hands-only CPR worked best for specific types of cardiac arrest, typically instances resulting from an abnormal heart rhythm (and requiring defibrillation).

Further research is needed to determine whether a combination of CPR with mouth-to-mouth is better at saving lives in certain types of cardiac arrest, and also to find out whether the public can be trained to tell one type of heart attack from another.

CPR performed by bystanders is known to almost double the survival chances of patients suffering from sudden cardiac arrest.

Source: The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System

In publicly funded health systems with finite resources, management decisions are based on assessments of clinical effectiveness and cost-effectiveness. The UK National Institute for Health and Clinical Excellence commissioned a systematic review to inform their 2009 update to guidance on the use of antiviral drugs for the treatment of influenza.

We searched databases for studies of the use of neuraminidase inhibitors for the treatment of seasonal influenza. We present the results for healthy adults (ie, adults without known comorbidities) and people at-risk of influenza-related complications. There was an overall reduction in the median time to symptom alleviation in healthy adults by 0·57 days (95% CI −1·07 to −0·08; p=0·02; 2701 individuals) with zanamivir, and 0·55 days (95% CI −0·96 to −0·14; p=0·008; 1410 individuals) with oseltamivir.

In those at risk, the median time to symptom alleviation was reduced by 0·98 days (95% CI −1·84 to −0·11; p=0·03; 1252 individuals) with zanamivir, and 0·74 days (95% CI −1·51 to 0·02; p=0·06; 1472 individuals) with oseltamivir. Little information was available on the incidence of complications.

In view of the advantages and disadvantages of different management strategies for controlling seasonal influenza in healthy adults recommending the use of antiviral drugs for the treatment of people presenting with symptoms is unlikely to be the most appropriate course of action.