Abstract

Background Out-of-hospital cardiac arrest (OHCA) has high mortality, and bystander cardiopulmonary resuscitation (CPR) improves outcomes. The effectiveness of chest compression-only CPR (CCO) versus standard CPR (sCPR) with ventilation remains unclear. This meta-analysis assesses their impact on survival, neurological recovery, and return of spontaneous circulation (ROSC).

Methods A systematic review and meta-analysis followed PRISMA guidelines. PubMed, Scopus, Web of Science, Embase, Google Scholar, and Cochrane Library were searched. Eligible studies included RCTs and observational studies on adult OHCA. Pediatric and non-original studies were excluded. Primary outcomes were survival to hospital discharge (SHD) and neurological recovery, while secondary outcomes included ROSC, survival to hospital admission, and 24-hour and one-month survival. Study quality was assessed using ROB-2 for RCTs and the Newcastle-Ottawa Scale (NOS) for observational studies. A random-effects model was applied, and publication bias was evaluated.

Results A total of 18 studies (5 RCTs, 13 observational) with 232,655 OHCA cases were analyzed. SHD rates showed no significant difference (OR = 0.85, 95% CI: 0.61–1.19, P = 0.29). Favorable neurological outcomes were similar (OR = 0.87, 95% CI: 0.64–1.20, P = 0.32). Prehospital ROSC rates were comparable (OR = 1.06, 95% CI: 0.89–1.27, P = 0.43). No difference was found in survival to hospital admission (OR = 1.12, 95% CI: 0.53– 2.29, P = 0.34). For 24-hour mortality, no difference was found (OR = 0.92, 95% CI: 0.83–1.01, P = 0.07), but sCPR had lower survival after sensitivity analysis (OR = 0.90, 95% CI: 0.82–1.00, P = 0.04). One-month mortality was similar (OR = 1.26, 95% CI: 0.98–1.62, P = 0.07), but sCPR had a higher risk after outlier removal (OR = 1.32, 95% CI: 1.02–1.71, P = 0.03). Hospital discharge rates showed no difference (OR = 0.79, 95% CI: 0.36–1.72, P = 0.55). SHD with favorable neurological outcomes did not differ significantly (OR = 1.47, 95% CI: 0.09–22.68, P = 0.61). Subgroup analyses indicated sCPR benefits in witnessed arrests and shockable rhythms.

Conclusion No significant differences were found between CCO and sCPR in key survival outcomes. While sCPR may benefit specific subgroups, CCO remains an effective alternative that increases bystander participation. Further research is needed to refine guidelines

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

None

Author Declarations

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Meta-analysis done from published data

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Footnotes

ashkanbahrami1998gmail.com, eshraghi.rzagmail.com, Sinasadati78gmail.com, ashkanbahrami1998gmail.com, eshraghi.rzagmail.com, Sinasadati78gmail.com, ehsanaminisalehi1998gmail.com, bahar.darueigmail.com, reza.amani.b13gmail.com, mazaheri.sadegh99gmail.com, mazaheri.sadegh99gmail.com, Pouyaebrahimi1992gmail.com, rmovaaol.com

Data Availability

Data is Publicly available as meta Analysis

Abbreviation listOHCAOut-of-Hospital Cardiac ArrestCPRCardiopulmonary ResuscitationCCO-CPRChest Compression-Only Cardiopulmonary ResuscitationsCPRStandard Cardiopulmonary Resuscitation (compression + ventilation)SHDSurvival to Hospital DischargeROSCReturn of Spontaneous CirculationRCTRandomized Controlled TrialOROdds RatioCIConfidence IntervalEMSEmergency Medical ServicesAEDAutomated External DefibrillatorVFVentricular FibrillationVTVentricular TachycardiaPEAPulseless Electrical ActivityNOSNewcastle-Ottawa ScaleROB-2Revised Cochrane Risk-of-Bias ToolBLSBasic Life SupportAHAAmerican Heart AssociationERCEuropean Resuscitation CouncilCPCCerebral Performance Category