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O ut-of hospital cardiac arrest (OHCA) is a leading cause of death worldwide.1,2 Resuscitation is challenging but achievable and relies in part on the chain of survival that includes early arrest recognition and emergency activation, early cardiopulmonary resuscitation (CPR), early defibrillation, expert advanced life support, and integrated postresuscitation care.3 Specifically, early CPR performed by laypersons can double the chances of survival and provides an important foundation for subsequent links in the chain of survival. 4 In most communities, however, fewer than half of all persons who have had cardiac arrests receive bystander CPR before the arrival of professional rescuers. Clinical Perspective on p 441Different approaches have been used to encourage and improve bystander CPR. One such approach is for the lay rescuer to provide bystander CPR that consists of chest compressions only in contrast to traditional CPR that comprises chest compressions interposed with rescue breathing. Chest compression alone is easier and quicker to initiate and so might provide for earlier CPR among a greater number of persons with OHCA. However, the comparative effectiveness of chest compression alone versus traditional CPR performed by laypersons Background-Little is known about the long-term survival effects of type-specific bystander cardiopulmonary resuscitation (CPR) in the community. We hypothesized that dispatcher instruction consisting of chest compression alone would be associated with better overall long-term prognosis in comparison with chest compression plus rescue breathing. Methods and Results-The investigation was a retrospective cohort study that combined 2 randomized trials comparing the short-term survival effects of dispatcher CPR instruction consisting either of chest compression alone or chest compression plus rescue breathing. Long-term vital status was ascertained by using the respective National and State death records through July 31, 2011. We performed Kaplan-Meier method and Cox regression to evaluate survival according to the type of CPR instruction. Of the 2496 subjects included in the current investigation, 1243 (50%) were randomly assigned to chest compression alone and 1253 (50%) were randomly assigned to chest compression plus rescue breathing. Baseline characteristics were similar between the 2 CPR groups. During the 1153.2 person-years of follow-up, there were 2260 deaths and 236 long-term survivors. Randomization to chest compression alone in comparison with chest compression plus rescue breathing was associated with a lower risk of death after adjustment for potential confounders (adjusted hazard ratio, 0.91; 95% confidence interval, 0.83-0.99; P=0.02). Conclusions-The findings provide strong support for long-term mortality benefit of dispatcher CPR instruction strategy consisting of chest compression alone rather than chest compression plus rescue breathing among adult patients with cardiac arrest requiring dispatcher assistance. (Circulation. 2013;127:435-441.)

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