No Breaths Required

From American Red Cross of Santa Monica

Rescue breathing, or 'mouth to mouth,' does not improve outcomes for people who experience an out of hospital cardiac arrest and are ministered to by bystanders, and can therefore be safely forgone, two studies and an editorial in this week's New England Journal of Medicine conclude.  Chest compressions, of course, are crucial, and should be administered at a rate of about 100 per minute until emergency medical services personnel take over.

Chest compressions need to be started as soon as possible in someone who has no pulse, Rick points out in this week's podcast.  Compressions need to be vigorous enough in adults to depress the rib cage about 2 inches.  That rate and depth of compression are adequate to continue to move blood throughout the body and maintain minimal oxygen levels in tissues.

We have known for some time that the breathing aspect of cardiopulmonary resuscitation or CPR was of lesser importance than the compressions, but these two studies provide compelling data.  In one study dispatchers randomly assigned bystanders to perform CPR with or without rescue breathing and outcomes were compared.  In the second study 30 day mortality among a cohort randomly assigned to compression only or CPR with rescue breathing was determined. Neither study detected a significant difference between the compression only or rescue breathing CPR groups.

These studies are good news because there are two major compelling issues with bystander initiated CPR that can now be relegated to the trash bin.  One is that bystanders often cite complexity of the technique as precluding their use of CPR.  Now that compressions only are required complexity isn't an issue.

Bystanders also say they're reluctant to perform 'mouth to mouth' on someone they don't know, so they don't begin CPR.  Now no bodily fluids need to be exchanged nor lips locked.  Hopefully this change in the technique will improve the rather lackluster rate (15 to 30% depending on the community involved) at which CPR is begun by those who witness an apparent heart attack.

Things to keep in mind are that people who have apparently drowned and children do need to have rescue breathing performed to restore oxygen to their lungs.  Often children are those who have drowned or they may have an object in their airway, so checking that is necessary before rescue breathing is begun.  Myron Weisfeldt, author of the accompanying editorial to these studies, predicts that for health care providers, rescue breathing will still be taught and retained for certification, but that bystanders can now feel confident that they're helping by performing chest compressions until the arrival of EMS personnel.

Other topics in this week's podcast include heart problems in childhood cancer survivors and prostate cancer management in men with low PSA levels in this issue of Archives of Internal Medicine, and complications of obesity surgery in JAMA.  Until next week, y'all live well.

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