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In cases of cardiac arrest associated with an opioid overdose, outcomes may be improved if bystander CPR is administered that includes both mouth-to-mouth rescue breathing as well as chest compressions, according to a large cohort study of 10,923 out-of-hospital cardiac arrest (OHCA) cases in British Columbia. As published in JAMA Network Open, researchers investigated the impact of bystander CPR techniques on neurologic outcomes, including among opioid-associated OHCA (OA-OHCA) cases. Of the 1,343 OA-OHCA cases studied, chest compression CPR plus ventilation CPR was significantly associated with higher odds of favorable neurologic outcomes at hospital discharge compared to chest compression–only CPR (adjusted odds ratio 2.85, 95% CI 1.21–6.75). However, a similar result was not observed in the other 9,556 undifferentiated OHCA cases. In those cases, no CPR was linked to worse outcomes, but chest compression CPR plus ventilation CPR did not improve outcomes over compression-only CPR. In a separate commentary, experts note that chest compression-only CPR has been the preference since 2010 because it’s easier for bystanders to perform. However, with this study finding that chest compression-only CPR is much less effective for patients with OA-OHCA, the commenters suggest that future guidelines may change.
Quick thinking: The study’s findings suggest that different CPR strategies may be helpful for different cardiac arrest situations. According to the American Heart Association (AHA), less than 40% of adults with OHCA receive layperson-initiated CPR, and fewer than 12% have an automated external defibrillator (AED) applied before emergency medical service arrival. In urgent care, the ability to provide ventilation, chest compressions, and possible shock with an AED while emergency transport arrives is valuable. The next full AHA CPR guideline release is scheduled for October 22, 2025.
Read what the AAP has to say: AAP Offers Guidelines for Pediatric Opioid Prescribing