Chest compression-only vs standard CPR in adults with out-of-hospital cardiac arrest (OHCA) Cardiac and neurological outcomes

Abstract

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) has high mortality, and bystander cardiopulmonary resuscitation (CPR) improves outcomes. The comparative effectiveness of chest compression-only CPR (CCO) versus standard CPR (sCPR) with ventilation remains uncertain. METHODS: We systematically searched PubMed, Scopus, Web of Science, Embase, Google Scholar, and Cochrane Library for randomized controlled trials (RCTs) and observational cohorts of adult OHCA comparing bystander CCO and sCPR. Primary outcomes were survival to hospital discharge and favourable neurological outcome; secondary outcomes were prehospital return of spontaneous circulation (ROSC), survival to hospital admission, 24 h survival, and one-month mortality. RESULTS: Eighteen studies (5 RCTs, 13 observational cohorts) including 232,655 OHCA cases (CCO n = 152,632; sCPR n = 80,023). Survival to hospital discharge was similar (OR 0.85; 95 CI 0.61-1.19). Favourable neurological outcome at discharge did not differ (OR 0.87; 95 CI 0.64-1.20). Prehospital ROSC (OR 1.06; 95 CI 0.89-1.27) and survival to admission (OR 1.12; 95 CI 0.79-1.49) were similar. For 24 h mortality (OR 0.92; 95 CI 0.83-1.01), sensitivity analyses suggested lower survival with sCPR (OR 0.87-0.90). One-month mortality was similar overall (OR 1.26; 95 CI 0.98-1.62), but higher after CCO in sensitivity analyses (OR 1.32; 95 CI 1.02-1.71). CONCLUSION: In adult OHCA, CCO and sCPR yield similar survival and neurological outcomes; CCO remains effective, simple strategy that may enhance bystander CPR delivery (c) 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.