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| Brief CPR Needs No Mouth-to-Mouth Chest compression alone just as good at saving lives by Adam Marcus - (HealthSCOUT) - 24 May 00 - Performing mouth-to-mouth resuscitation does not improve survival rates for heart stoppage victims who receive CPR from untrained bystanders, new research shows. The study, by University of Washington scientists, found that patients who received mouth-to-mouth were no more likely to reach the hospital alive, or to leave it that way, than those who got rhythmic chest compression, but no breathing help. Experts cautioned that the findings might not apply beyond the Seattle area, which has extremely fast response times by emergency medical workers. Even so, they say, the work does suggest that telephone dispatchers can feel confident instructing bystanders to perform CPR without mouth-to-mouth -- which many people shy away from over infection fears -- in the right circumstances. A report on the finding appears in the May 25 issue of the New England Journal of Medicine. Cardiopulmonary resuscitation does two things: Rhythmic chest compression acts as a surrogate heartbeat, pumping blood from the stalled organ throughout the body; and mouth-to-mouth supplies the lungs with air, which in turn feeds oxygen to the heart. Conventional wisdom has operated on the assumption that once the heart stops beating, its main blood vessels quickly run out of oxygen. New research in animals, however, shows that these vessels remain nourished for some time, perhaps several minutes, after arrest. The study compared survival and hospitalization rates among 520 cardiac arrest victims who received either chest compression alone or with mouth-to-mouth from untrained bystanders coached through the procedures by emergency dispatchers. Those given chest compression were more likely to survive long enough to be admitted to the hospital, and more likely to go home from it alive, though the differences weren't statistically significant. Still, the researchers say that the results, which match an earlier finding by the Seattle group, indicate that mouth-to-mouth offers no advantage over chest pressing, at least in the short run. "If you have to do CPR for an extended period time you're going to have to ultimately reoxygenate the blood," says Al Hallstrom, a professor of biostatistics at the University of Washington School of Public Health and a co-author of the study. Mouth-to-mouth is absolutely necessary, he says, in cases of respiratory arrest. These typically involve young victims, and frequently result from drug overdose. A simpler walk-through Timing of CPR is key, particularly during the first four minutes after the heart stops. And chest compression was quicker to coach than mouth-to-mouth -- nearly 1.5 minutes faster, the researchers found. Dispatchers were also more likely to completely deliver the instructions for chest compression, doing so in 81 percent of cases vs. 62 percent for chest compression plus mouth-to-mouth. Anything that makes CPR easier to administer and more palatable to bystanders is critical, experts say, since the odds of receiving the potentially lifesaving procedure before an ambulance arrives are barely 50-50. Much of the reticence involves fear of AIDS and other infections, though no solid evidence supports a link between these diseases and CPR, Hallstrom notes. Indeed, one study of nearly 1,000 people told to imagine they knew CPR found that only 15 percent said they would aid a victim if mouth-to-mouth was required. That number rose to 68 percent when only chest compression was necessary. But the American Heart Association, which, along with the American Red Cross offers training guidelines for CPR, says people shouldn't discard mouth-to-mouth. "A trained rescuer is very likely going to increase the chances of survival by doing mouth-to-mouth along with chest compression," says Jerry Potts, director of science for the AHA's emergency cardiovascular care programs, in a statement released today. "However, we do realize that some people are not able or willing to do mouth-to-mouth. Regardless, people should be taught both components of CPR and be able to respond quickly if someone near them has cardiac arrest," Potts says. "Calling 911 if someone is having cardiac arrest is critical in saving a person's life," he adds. What To Do: To learn more about cardiopulmonary resuscitation, visit the American Heart Association or Learn CPR, a Web site devoted to CPR information. SOURCES: Interviews with Al Hallstrom, Ph.D., professor of biostatistics, University of Washington School of Public Health, Seattle, and statement, Jerry Potts, Ph.D., American Heart Association; May 25, 2000 New England Journal of Medicine.
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