CPR: Just Chest Compressions, Mouth-to-Mouth Not Necessary

New Guidelines for CPR

Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR

Care for patients is a combination of high tech and high touch and the American Heart Association is working hard to get the touch back into the equation. After years of advocating bystander CPR, cardiopulmonary pulmonary resuscitation, the "P" or pulmonary is being dropped and chest compressions may be enough.

Why the change? Because when many bystanders are confronted with a medical crisis, such as somebody collapsing with their heart stopping, they are too frightened to intervene. Often they are not certain whether they might even do harm. And with today's fear of getting an infection from an unknown person, doing mouth to mouth breathing on a stranger can add to that fear. The concept might be summarized by the axiom: if you can't do something well, don't do it at all.

But in a medical crisis, people who try to help make a difference and the result is patients survive. Studies have shown that bystanders who had no knowledge of CPR, were given simple instructions by 911 operators to do chest compressions and were able to save lives. It seems that there is often enough oxygen left in the blood stream to allow the brain and other organs to survive until medically trained personnel arrive, as long as that blood is circulated, and chest compressions does just that.

As usual, there are special situations where breathing for a victim is important, including babies and drowning victims, but the new recommendations make it easier for bystanders to make a difference.

The first steps remain the same:

  • Make certain the victim is unconscious and doesn't have a pulse

  • If possible, send one person to call 911, send another to find an AED (automatic defibrillator)

  • Begin chest compressions

  • Don't stop until either the patient wakes up (yes, this does happen), the rescuer gets too tired to continue, or help arrives and ask that you stop

The best chance for a victim of heart attack to survive depends on the quick use of devices that can electrically stimulate a proper heartbeat. An AED, or automatic defibrillator, can shock the heart back into a rhythm where it can beat and sustain life. But until the AED arrives on the scene, chest compressions are a bridge for saving a life.

There is no doubt, that the chances of survival for victims of heart attack (or heart stoppage) are better in certain situations, like in a hospital intensive care unit. There is also a better chance of survival in Seattle, where many people have taken a CPR class, than in a city where ordinary citizens have not. Using chest compressions alone is good, but learning the whole package is certainly better, and advocating for more AEDs in public places adds to the overall survival rate in a community.

But the high tech can't work unless the high touch happens. The new recommendation for chest compressions "hands only" CPR may make that difference between life and death.


Last Editorial Review: 4/1/2008



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