Effective CPR Without Mouth-to-Mouth Resuscitation

The Myth: Performing cardiopulmonary resuscitation correctly requires continuous mouth-to-mouth breathing.

The American Heart Association (AHA) 2010 recommendations advise against breathing on someone while administering cardiopulmonary resuscitation (CPR)—not because it’s bad for you, but because it reduces the odds of survival for the individual having a cardiac arrest.

The old standard of cardiopulmonary resuscitation (CPR)—15 chest compressions followed by 2 breaths—may be familiar to you if you received your training many years ago. You are probably already familiar with the 30-press-two-breathe method if you used the 2005 recommendations. You ought to toss things out the window in both instances.

The International Liaison Committee on Resuscitation (ILCOR) concluded in 2010 after reviewing a large body of research that cardiopulmonary resuscitation (CPR) patients need not breathe while administering the procedure.

There is a limited role for even highly trained medical professionals, such as doctors and paramedics, to breathe for someone experiencing cardiac arrest. Although the research supporting this seemingly radical change in treatment has been available for more than a decade, Americans have only now begun to take notice (several European nations altered their recommended procedure long before Americans did).

Circulating blood and delivering oxygen and nutrients to all of our bodily organs and tissues is the heart’s primary function. All of our bodily systems—hearts, lungs, livers, kidneys, etc.—are interchangeable, but ultimately, they all serve to sustain our brains.

Internal pressure is generated throughout the circulatory system (arteries and veins) by the heart’s pumping motion. When you eat a lot of cheese and beer, your blood pressure goes up, and this is recorded in millimeters of mercury.

By applying pressure to the heart during chest compressions, we can simulate this pumping action. The heart pumps the blood into the bloodstream against the patient’s will. As soon as the pressure is reduced, blood is drawn back into the heart through the closed circulatory system, where it is prepared to be released once more.

To ensure enough blood flow to the brain, a certain blood pressure level is required. According to a plethora of research, the pressure needed to pump blood to the brain is equal to roughly ten consecutive chest compressions. The blood pressure returns to zero the second that chest compressions are stopped, as happens when someone is being breathed on.

In light of these findings, it is clear that traditional cardiopulmonary resuscitation techniques were only successful in delivering blood to the brain 1/3 of the time. Increasing the number of compressions became the standard treatment as the goal of cardiopulmonary resuscitation (CPR) is to restore brain function by delivering blood to the brain.

This led ILCOR to reconsider its position on the priority of resuscitation. For a long time, the tried-and-true A-B-Cs acronym stood for the three most crucial aspects of cardiopulmonary resuscitation: airway patency, breathing, and circulation. The current recommendation is C-A-B to stress the significance of compressions over breathing.

About four to six minutes after blood flow stops, brain cells start to die. The likelihood of recovering function within those cells decreases by around 10% per minute thereafter. A person will be considered brain dead approximately 10 to 16 minutes after their heart stops.

Although it is technically feasible to restart their hearts, there is currently no benefit for that individual. Anyhow, they’re completely brain-dead. If, on the other hand, you managed to revive them, you now have a veritable organ bank from which surgeons can draw (assuming, of course, that you are a donor; after all, you won’t need those organs when you die or are otherwise brain dead, and plenty of people are).

You may be asking why, in this day and age, they don’t advise the breathing stage if oxygen is still necessary. The brain continues to attempt to operate at the time of cardiac arrest, but its oxygen capacity is inadequate.

The brain’s respiratory centers—the medulla oblongata and the pons region—keep trying to keep the diaphragm from stopping to deliver signals that will cause respiration to continue. Agonal respiration is the outcome of this process. Even though this breathing style can’t keep a person’s blood oxygen levels up for very long, it can allow for a small exchange of gases in the lungs.

When a heart attack occurs, the blood oxygen level is high enough to keep the brain’s metabolism going for a short while. It is not essential to breathe for someone while you wait for emergency help because their metabolism will use up this available oxygen eventually. However, when combined with agonal respiration, this effect can be mitigated.

The actual duration of time during which breathing isn’t required varies from study to study, which is a major drawback. Nonetheless, ILCOR examined research that utilized varying ventilation-to-compression ratios, ranging from fifteen compressions to two breaths to one hundred compressions to one breath—and even studies that solely used compressions—and found consistent trends, even though the survival rates varied across studies. Patients had a higher probability of survival if chest compressions were performed with as little interruption as possible, even for breathing.

You could assume that the arrival of paramedics or doctors brings a plethora of cutting-edge equipment and medications that can revive a person’s vital signs. Their efforts to revive someone mostly center on cardiopulmonary resuscitation (CPR) and chest compressions.

Highly Debated Topics Around CPR

  • There’s an ongoing debate about the comparative effectiveness of AEDs versus manual CPR in cardiac arrest situations. While AEDs provide automated electric shocks, is their efficacy greater than manual CPR’s chest compressions in terms of survival rates and neurological outcomes?
  • Discussions center on the ethical dilemmas of prioritizing chest compressions over mouth-to-mouth resuscitation. Are there socio-cultural biases affecting the decisions to minimize mouth-to-mouth breathing in CPR? Is there potential discrimination against this aspect due to hygiene concerns?
  • The public’s confidence in administering CPR techniques is an ongoing concern. Does the shift away from mouth-to-mouth contribute to increased willingness among laypeople to perform CPR? Or does the emphasis on chest compressions lead to misunderstandings about the holistic approach to resuscitation?
  • The debate revolves around the inclusion of compression-only CPR in training and education programs. Are educational initiatives adequately addressing the shift in CPR guidelines towards emphasizing chest compressions, or is there a need for more widespread dissemination of this information?
  • There’s a lack of consensus on the efficacy of compression-only CPR in special populations such as infants, children, or those with specific medical conditions. How effective and safe is compression-only CPR in these groups, and should there be different guidelines for administering CPR to them?

How To Conduct Proper CPR Without Mouth to Mouth

  • Ensure the scene is safe before approaching the victim. Check for responsiveness by tapping the victim and asking loudly if they’re okay. If unresponsive, ensure they’re lying on their back and check their breathing. Scan for normal breathing for no more than 10 seconds. If they’re not breathing normally, begin chest compressions.
  • Position yourself at the victim’s chest level. Place the heel of one hand on the center of the victim’s chest, then put your other hand on top, interlacing your fingers. Keep your arms straight and your shoulders directly above your hands.
  • Push hard and fast in the center of the chest, aiming for a depth of at least 2 inches. Use your upper body weight to perform compressions at a rate of about 100 to 120 beats per minute. Remember to allow the chest to fully recoil between compressions.
  • Continue compressions continuously until emergency services arrive or until the victim shows signs of life. Minimize interruptions as much as possible, only stopping if the victim starts breathing normally or shows signs of movement or responsiveness.
  • If an AED is available, turn it on and follow the visual and auditory prompts. Attach the pads to the victim’s bare chest as shown on the AED. If prompted, stand clear of the victim and analyze their heart rhythm. Follow the AED’s instructions for administering a shock if advised. Resume CPR immediately after the shock is delivered, starting with chest compressions.

Nowadays, breathing is practically an afterthought; it is only addressed when there are sufficient personnel to administer chest compressions and activate a defibrillator. After that is accomplished, the next step is to deal with breathing. No matter how serious the situation, the patient will never be allowed to stop receiving chest compressions just so they may breathe.

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