Hemodynamic tissue perfusion is regulated by the pumping heart; the specialized cardiac cells have an autorhythm property that enables the heart to beat throughout life. When the pumping capability of the heart diminishes due to tissue ischemia, it leads to dysfunction. Pathological factors result in a decreased supply of blood to cardiac cells. Coronary circulation is at risk of stenosis due to spasm, plaque, or sclerosis, causing tissue hypoxia, injury, and necrosis. The ischemia of cardiac tissue leads to cardiac arrest, commonly known as a cardiac attack. Early intervention for a cardiac attack restores the vitality of the cardiac tissues. The approaches for cardiac revascularization involve drug administration of sodium nitrate, aspirin, statin, and clopidogrel, which are vasodilators, blood thinners, antiplatelets, and antithrombotics, and manual chest compression at a rate of 100–150 beats per minute. Chest compression can be performed by professionals and nonprofessionals. The professional performs cardiopulmonary resuscitation (CPR), supporting ventilation and contraction of the heart; the nonprofessional can perform compression-only life support (COLS), which supports cardiac output and maintains cardiac and vital organ tissue perfusion. This review is a brief description of the concept of COLS, its method of administration, the standardized algorithm for the performance of COLS, and the concept of the first responder (a person who attends to a cardiac victim in an emergency) and their roles and responsibilities.

Keywords: Cardiac ischemia, coronary circulation, compression-only life support (COLS), cardiopulmonary resuscitation (CPR), cardiac revascularization

🔒 This is a subscription article

Full text is available to subscribers and institutional members. Please choose an option below to access it.

1. American Heart Association. Hands-only CPR fact sheet. 2017. Available from:

https://cpr.heart.org/en/-/media/CPR-Files/Training-Programs/Community-Programs/Heroes-with-CPR/English_CPR_Fact_Sheet_Heroes_Saving_Hearts.pdf?sc_lang=en

2. Hallstrom A, Cobb L, Johnson E, Copass M. Cardiopulmonary resuscitation by chest compression alone or with mouth-to-mouth ventilation. N Engl J Med. 2000 May 25;342(21):1546–53. doi: 1056/NEJM200005253422101. PMID: 10824072.
3. Rea TD, Fahrenbruch C, Culley L, Donohoe RT, Hambly C, Innes J, et al. CPR with chest compression alone or with rescue breathing. N Engl J Med. 2010 Jul 29;363(5):423–33. doi: 1056/NEJMoa0908993. PMID: 20818863.
4. Svensson L, Bohm K, Castrèn M, Pettersson H, Engerström L, Herlitz J, et al. Compression-only CPR or standard CPR in out-of-hospital cardiac arrest. N Engl J Med. 2010 Jul 29;363(5):434–42. doi: 1056/NEJMoa0908991. PMID: 20818864.
5. Bohm K, Rosenqvist M, Herlitz J, Hollenberg J, Svensson L. Survival is similar after standard treatment and chest compression only in out-of-hospital bystander cardiopulmonary resuscitation. Circulation. 2007 Dec 18;116(25):2908–12. doi: 1161/CIRCULATIONAHA.107.710194. PMID: 18071077.
6. Iwami T, Kawamura T, Hiraide A, Berg RA, Hayashi Y, Nishiuchi T, et al. Effectiveness of bystander-initiated cardiac-only resuscitation for patients with out-of-hospital cardiac arrest. Circulation. 2007 Dec 18;116(25):2900–7. doi: 1161/CIRCULATIONAHA.107.723411. PMID: 1807107.
7. Ong ME, Ng FS, Anushia P, Tham LP, Leong BS, Ong VY, et al. Comparison of chest compression only and standard cardiopulmonary resuscitation for out-of-hospital cardiac arrest in Singapore. 2008 Aug;78(2):119–26. doi: 10.1016/j.resuscitation.2008.03.012. PMID: 18502559.
8. Olasveengen TM, Wik L, Steen PA. Standard basic life support vs continuous chest compressions only in out-of-hospital cardiac arrest. Acta Anaesthesiol Scand. 2008 Aug;52(7):914–9. doi: 1111/j.1399-6576.2008.01723.x. PMID: 18702753.
9. Waalewijn RA, Tijssen JG, Koster RW. Bystander initiated actions in out-of-hospital cardiopulmonary resuscitation: Results from the Amsterdam Resuscitation Study (ARRESUST). Resuscitation. 2001 Sep;50(3):273–9. doi: 1016/s0300-9572(01)00354-9. PMID: 11719156.
10. SOS-KANTO study group. Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): An observational study. Lancet. 2007 Mar 17;369(9565):920-6. doi: 10.1016/S0140-6736(07)60451-6. PMID: 17368153.
11. Van Hoeyweghen RJ, Bossaert LL, Mullie A, Calle P, Martens P, Buylaert WA, et al. Quality and efficiency of bystander CPR. Belgian Cerebral Resuscitation Study Group. Resuscitation. 1993 Aug;26(1):47–52. doi: 1016/0300-9572(93)90162-j. PMID: 8210731.
12. Hüpfl M, Selig HF, Nagele P. Chest-compression-only versus standard cardiopulmonary resuscitation: A meta-analysis. Lancet. 2010 Nov 6;376(9752):1552–7. doi: 1016/S0140-6736(10)61454-7. PMID: 20951422; PMCID: PMC2987687.

Hemodynamic tissue perfusion is regulated by the pumping heart; the specialized cardiac cells have an autorhythm property that enables the heart to beat throughout life. When the pumping capability of the heart diminishes due to tissue ischemia, it leads to dysfunction. Pathological factors result in a decreased supply of blood to cardiac cells. Coronary circulation is at risk of stenosis due to spasm, plaque, or sclerosis, causing tissue hypoxia, injury, and necrosis. The ischemia of cardiac tissue leads to cardiac arrest, commonly known as a cardiac attack. Early intervention for a cardiac attack restores the vitality of the cardiac tissues. The approaches for cardiac revascularization involve drug administration of sodium nitrate, aspirin, statin, and clopidogrel, which are vasodilators, blood thinners, antiplatelets, and antithrombotics, and manual chest compression at a rate of 100–150 beats per minute. Chest compression can be performed by professionals and nonprofessionals. The professional performs cardiopulmonary resuscitation (CPR), supporting ventilation and contraction of the heart; the nonprofessional can perform compression-only life support (COLS), which supports cardiac output and maintains cardiac and vital organ tissue perfusion. This review is a brief description of the concept of COLS, its method of administration, the standardized algorithm for the performance of COLS, and the concept of the first responder (a person who attends to a cardiac victim in an emergency) and their roles and responsibilities.

Keywords: Cardiac ischemia, coronary circulation, compression-only life support (COLS), cardiopulmonary resuscitation (CPR), cardiac revascularization

🔒 This is a subscription article

Full text is available to subscribers and institutional members. Please choose an option below to access it.

1. American Heart Association. Hands-only CPR fact sheet. 2017. Available from:

https://cpr.heart.org/en/-/media/CPR-Files/Training-Programs/Community-Programs/Heroes-with-CPR/English_CPR_Fact_Sheet_Heroes_Saving_Hearts.pdf?sc_lang=en

2. Hallstrom A, Cobb L, Johnson E, Copass M. Cardiopulmonary resuscitation by chest compression alone or with mouth-to-mouth ventilation. N Engl J Med. 2000 May 25;342(21):1546–53. doi: 1056/NEJM200005253422101. PMID: 10824072.
3. Rea TD, Fahrenbruch C, Culley L, Donohoe RT, Hambly C, Innes J, et al. CPR with chest compression alone or with rescue breathing. N Engl J Med. 2010 Jul 29;363(5):423–33. doi: 1056/NEJMoa0908993. PMID: 20818863.
4. Svensson L, Bohm K, Castrèn M, Pettersson H, Engerström L, Herlitz J, et al. Compression-only CPR or standard CPR in out-of-hospital cardiac arrest. N Engl J Med. 2010 Jul 29;363(5):434–42. doi: 1056/NEJMoa0908991. PMID: 20818864.
5. Bohm K, Rosenqvist M, Herlitz J, Hollenberg J, Svensson L. Survival is similar after standard treatment and chest compression only in out-of-hospital bystander cardiopulmonary resuscitation. Circulation. 2007 Dec 18;116(25):2908–12. doi: 1161/CIRCULATIONAHA.107.710194. PMID: 18071077.
6. Iwami T, Kawamura T, Hiraide A, Berg RA, Hayashi Y, Nishiuchi T, et al. Effectiveness of bystander-initiated cardiac-only resuscitation for patients with out-of-hospital cardiac arrest. Circulation. 2007 Dec 18;116(25):2900–7. doi: 1161/CIRCULATIONAHA.107.723411. PMID: 1807107.
7. Ong ME, Ng FS, Anushia P, Tham LP, Leong BS, Ong VY, et al. Comparison of chest compression only and standard cardiopulmonary resuscitation for out-of-hospital cardiac arrest in Singapore. 2008 Aug;78(2):119–26. doi: 10.1016/j.resuscitation.2008.03.012. PMID: 18502559.
8. Olasveengen TM, Wik L, Steen PA. Standard basic life support vs continuous chest compressions only in out-of-hospital cardiac arrest. Acta Anaesthesiol Scand. 2008 Aug;52(7):914–9. doi: 1111/j.1399-6576.2008.01723.x. PMID: 18702753.
9. Waalewijn RA, Tijssen JG, Koster RW. Bystander initiated actions in out-of-hospital cardiopulmonary resuscitation: Results from the Amsterdam Resuscitation Study (ARRESUST). Resuscitation. 2001 Sep;50(3):273–9. doi: 1016/s0300-9572(01)00354-9. PMID: 11719156.
10. SOS-KANTO study group. Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): An observational study. Lancet. 2007 Mar 17;369(9565):920-6. doi: 10.1016/S0140-6736(07)60451-6. PMID: 17368153.
11. Van Hoeyweghen RJ, Bossaert LL, Mullie A, Calle P, Martens P, Buylaert WA, et al. Quality and efficiency of bystander CPR. Belgian Cerebral Resuscitation Study Group. Resuscitation. 1993 Aug;26(1):47–52. doi: 1016/0300-9572(93)90162-j. PMID: 8210731.
12. Hüpfl M, Selig HF, Nagele P. Chest-compression-only versus standard cardiopulmonary resuscitation: A meta-analysis. Lancet. 2010 Nov 6;376(9752):1552–7. doi: 1016/S0140-6736(10)61454-7. PMID: 20951422; PMCID: PMC2987687.