CPR Without Rescue Breathing May Save More Lives

We know, even without studies, that some bystanders do not perform mouth to mouth breaths (rescue breathing) on collapsed cardiac victims due to fear of contracting diseases. Others, who may be trained in CPR already, fear they will not perform it correctly. In fact, only 1 in 5 out-of-hospital cardiac arrest victims receive bystander CPR even though the majority of these collapses may have been witnessed.

CPR (Cardiopulmonary Resuscitation) has been taught to individuals by the AHA (American Heart Association) for many years with mouth to mouth breathing as an important contributor to saving lives. Recent studies have shown that giving chest compressions alone can not only save a life, but in many ways is a preferable technique for cardiopulmonary resuscitation by non-healthcare bystanders on cardiac victims. In 2008, the AHA did update their standing that chest only compressions without rescue breathing are acceptable but many people may still not be aware of this change.

Why rescue breathing during CPR may not be helpful:

1. CPR with rescue breathing interrupts the rhythm of regular chest compressions which deliver vital heart and brain circulation. Valuable compression time is lost when bystanders try to give rescue breaths interspersed with chest compressions.

2. Cardiac arrest victims frequently gasp prior to their collapse so oxygen levels in their blood are sufficiently high at that point to do without rescue breathing. They need the forced compressions to move their blood around more than the need for additional oxygen.

3. During chest recoil from compressions, some air is passively sucked in so the person is still getting small amounts of oxygen even with compressions alone.

First, it is well documented in out-of-hospital studies that those who have an observed cardiac related collapse and are shocked soon after with defibrillators have the highest rates of survival. This is how the movement to provide AEDs (Automatic External Defibrillators) gained momentum and those devices are now available in many locations. However, the time period before the AED arrives is when CPR should be initiated. Chest only compressions should be initiated after calling 911 to get help at a rate of 100 compressions a minute. (see video link at the end of this article)

A study done in Japan in 2007 analyzed over 4,000 cases of witnessed cardiac collapse where victims were resuscitated by bystanders either with rescue breathing and cardiac compressions, with cardiac compressions alone or no attempt to resuscitate them at all was made. Cardiac resuscitation where bystanders used chest only compressions showed a19.4% favorable outcome vs. those who received both chest compressions and rescue breathing whose favorable outcome was only 11.2%.

Another study in 2008 in Norway lead by Katarina Bohm, RN compared survival rates of over 10,000 CPR patients where 10% received chest only compressions and 73 % received regular CPR. The one month survival rates showed no significant difference between using either form of resuscitation.

Dr. Gordon A. Ewy, the Director of the University of Arizona Sarver Heart Center, is an authority and pioneer in the drive to utilize CCR (Chest Compression Resuscitation) as the first response to be performed by bystanders in a witnessed cardiac collapse. Dr. Ewy states that while rescue breathing is of importance for those who have suffered a loss of oxygen such as near drowning, choking or drug overdose, in those with a witnessed cardiac collapse "we now know that not only is it not helpful, but it's often harmful."

With evidence to support chest compression resuscitation effectiveness, everyone can be taught and feel comfortable that giving chest only compressions without rescue breathing during a witnessed cardiac collapse may actually improve the chances that the victim's life may be saved. Standing by and doing nothing while waiting for the paramedics to arrive will certainly guarantee that the fallen person has little to no chance of survival.

Please go to the AHA "Hands only CPR" page to view their video http://handsonlycpr.eisenberginc.com/resources.html
A Friends and Family CPR practice kit can be purchased at the same page.

http://www.opa.medicine.arizona.edu/newsroom/releaseText.cfm?storyID=641

http://www.circ.ahajournals.org/cgi/content/full/111/16/2134

http://www.circ.ahajournals.org/cgi/content/abstract/116/25/2908

http://www.americanheart.org/presenter.jhtml?identifier=3057167

http://www.sciencedaily.com/releases/2007/03/070315210134.htm

http://www.sciencedaily.com/releases/2007/12/071226230920.htm