Schmicker RH, Nichol G, Kudenchuk P, et al. - In a large, randomized trial, no significant difference in survival to discharge was observed between cardiopulmonary resuscitation (CPR) strategies of 30 compressions with pause for 2 ventilations per cycle (30:2) and continuous chest compression with asynchronous ventilations (CCC). The same trial also described correlation of adherence to the intended CPR strategy with significantly greater survival. Researchers herein investigated the adherence rate with intended strategy and then examined how adherence associates with survival to discharge in the Resuscitation Outcomes Consortium (ROC). They conducted a secondary analysis of data from the ROC including three interventional trials and a prospective registry. Among 26,810 included adults experiencing out of hospital cardiac arrest, 10,942 had an intended strategy of 30:2 and 15,868 an intended strategy of CCC. For intended strategy CCC, significantly lower survival was observed, OR (95%CI) = 0.72 (0.64, 0.81), when adhered to while for intended strategy 30:2, higher survival was recorded, OR (95%CI) = 1.05 (0.90, 1.22), when adhered to. Relative to intended strategy CCC, lower adherence rates were observed in correlation with intended strategy of 30:2; this is possibly a result of being a more difficult strategy to administer.