Association of rescue breathing with outcomes in adult suffocation-related cardiac arrest.
Resuscitation · 2026-06-26 · Registry study
Abstract
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is a public health concern. Whether conventional cardiopulmonary resuscitation (CPR) with rescue breathing may improve outcomes compared with compression-only or no CPR in suffocation-related OHCA is unclear. METHODS: We conducted a retrospective cohort study using the All-Japan Utstein Registry (2005-2023). Adult patients with witnessed suffocation-related OHCA were included, excluding cardiac-origin cases and those treated by EMS personnel. Bystander CPR was categorized as chest compression-only CPR (CC-CPR), chest compression plus ventilation CPR (CCV-CPR), and no bystander CPR (No CPR), with CC-CPR as the reference. The primary outcome was favorable neurological status at one month; secondary outcomes were one-month survival and return of spontaneous circulation (ROSC). Inverse probability of treatment weighting (IPTW) was applied, and prespecified subgroup analyses were performed across year, age, sex, time of EMS call, bystander type, and initial rhythm. RESULTS: Among 76,774 patients, 39,451 received CC-CPR, 8182 received CCV-CPR, and 29,141 received No CPR. Favorable neurological outcome occurred in 1.5%, 1.5%, and 2.0%; one-month survival in 8.3%, 7.2%, and 9.5%; and ROSC in 19.9%, 17.2%, and 17.7%, respectively. After IPTW adjustment, No CPR was associated with a higher likelihood of favorable neurological outcomes compared with CC-CPR (adjusted OR: 1.20, 95%CI: 1.04-1.38), whereas CCV-CPR showed no significant difference (OR: 1.01, 95%CI: 0.78-1.32). No CPR was also associated with higher one-month survival (OR: 1.20, 95%CI: 1.12-1.28), with no significant difference for CCV-CPR. No significant differences were observed for ROSC. Findings were consistent in subgroup and sensitivity analyses using multiple imputation. CONCLUSIONS: In suffocation-related OHCA, the type of bystander CPR was not associated with improved neurological recovery. These findings suggest that the type of bystander CPR alone may not be the primary determinant of recovery, although the relative contributions of CPR type, airway management, and other prehospital factors remain to be clarified.