# CPR without Mouth to Mouth??



## MA-Caver (Jul 29, 2010)

Maybe I'm too much of a traditionalist or maybe this just strikes me as things NOT to do ... and that is change from PROVEN methods of resuscitating someone when they cannot breathe or is having a heart attack. 


> ATLANTA  More bystanders are willing to attempt CPR if an emergency  dispatcher gives them firm and direct instructions  especially if they  can just press on the chest and skip the mouth-to-mouth, according to  new research.
> The two new studies conclude that "hands-only" chest  compression is enough to save a life. They are the largest and most  rigorous yet to suggest that breathing into a victim's mouth isn't  needed in most cases.
> The American Heart Association has been promoting  hands-only CPR for two years, though it's not clear how much it's caught  on. The new studies should encourage dispatchers and bystanders to be  more aggressive about using the simpler technique.
> "That could translate into hundreds if not thousands  of additional lives saved each year. What are we waiting for?" said Dr.  Arthur Kellermann, a RAND Corporation expert on emergency medicine.
> ...



I understand that the idea of putting your mouth to someone else's (particularly a total stranger whom you have NO IDEA who or what they've been kissing/eating or whatever!) can be daunting and make you say EWWW... But is a simple ewww worth a human life? 
Oh aids/HIV... hmm good point... then get yourself some of these http://www.iprepare.com/cprmouthpiece.html or 
http://www.alwaysbeprepared.com/site/558697/product/FA-2SUM or
http://www.firstaidmonster.com/ambu-res-cue-resuscitation-mask-p-5460.html or even...
http://www.firstaidmonster.com/cpr-micro-shield-rescue-breather-in-orange-pouch-p-5890.html 
and keep them in your car or briefcase or purse or backpack or whatever it is you carry around your OTHER non-essentials/essentials in. 
Oxygen needs to be there to prevent brain damage. 
Besides I think a lot of people don't realize that once you've learned CPR and are current you are required to utilize it unless someone else or EMS is on the scene. 
Don't want to get sick, or taste their recent dinner? Then get a shield and keep it near you... 
Yeah, can't carry it EVERYWHERE but :idunno: nice to have when you got it eh? 

I love how it says EXPERTS now believe... oh they haven't proven it? *scoffs*... sorry to dis on experts but hey... like I just said... if it ain't broken don't fix it... the most recent/current method is jes fine.


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## Dirty Dog (Jul 29, 2010)

It says "believe" because nothing is 100% in the world of medicine. And we change the "proven" methods when something is proven to be more effective, or equally effective with lower risks.

There have been a number of studies out of Europe (which is generally a few years ahead of us in this area) showing that the survival rate for compression only CPR is equal to that of traditional compression/ventilation CPR. Given that the cardiac output during CPR is only about 25% of it's norm, the compressions move enough air to provide adequate gas exchange without specific ventilation efforts until such time as a secure airway can be placed. It's also been shown that bystanders are more likely to provide compression-only CPR than compression/ventilation CPR. 

Consider also that any method of ventilation available to the average bystander carries with it a significant chance that the victim will vomit. Why? Because you will nearly always inflate their stomache along with their lungs. And when you do, they're going to vomit. On you. And despite efforts to efforts to clear the mouth (without the suction devices we use) you're virtually gauranteed to blow that vomitus down into their lungs.

Expect compression-only CPR to become the accepted standard world wide over the next few years.


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## K-man (Jul 29, 2010)

Believe it or not, mouth to mouth resuscitation has been around for less than 50 years.  Prior to that we were taught to use movement of the arms to cause air to flow in and out of the lungs. 
http://www.texasonsitecpr.com/History.html
Other studies have come to the same conclusion as outlined in the OP.
Possibly part of the problem is the complexity of counting to 30 for the chest compresses, then lifting the chin, pinching the nostrils and blowing into the mouth while checking that the chest rises. Repeating, then back to compressions.
However, if someone wants to inflate the lungs, without putting their mouth over another person's mouth, they can blow through the patients nostrils. Unfortunately that takes longer but solves the initial problem.


> Mouth-to-nose Used when there is major trauma to the face, trismus, or a tight mouth seal cannot be formed; airway is opened by the head-tilt/jaw-lift maneuver, mouth is closed by Rescuer who takes 2 deep breaths, seals his/her lips around Patient's nose and gives 2 full breaths.



http://www.associatedcontent.com/article/180669/mouthtomouth_resuscitation_may_no_longer.html


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## Mark Jordan (Jul 29, 2010)

Any changes in CPR have been met with resistance, especially because the changes suggest deemphasizing "airway" and "breathing".  Anybody who know how to do CPR has been taught the ABCs of emergency care which are (in this order):

   1. Airway
   2. Breathing
   3. Circulation
This emphasises the importance of ensuring airway first. Only if the person does not have a pulse or signs of circulation, should we compress the chest to pump blood through the body.

Recently, there has been 2 studies done that clearly showed a benefit to chest compressions without doing mouth-to-mouth resuscitation. It focuses on pumping blood during CPR since there's still a significant amount of oxygen in the bloodstream capable of sustaining brain tissue for several minutes, even without breathing. 

This will also protect medical personnel and rescuers from HIV infection during rescue attempts.  

I think this new way of giving CPR should be taught anew to medical personnel as well as to ordinary people.


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## Andrew Green (Jul 29, 2010)

MA-Caver said:


> I love how it says EXPERTS now believe... oh they haven't proven it? *scoffs*... sorry to dis on experts but hey... like I just said... if it ain't broken don't fix it... the most recent/current method is jes fine.



If people are hesitant to do it, then for those people it is broken. 

CPR doesn't work unless someone actually does it. So if this new method increases the chances of someone actually doing something, then it is a improvement.

As far as proving it?  Medicine is far from a exact science, and I doubt there is a ethical way to really "prove" it.


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## Carol (Jul 29, 2010)

I think CPR (as performed by laypeople) offers quite a benefit to the  people that were in contact with the victim, giving them the peace of  mind knowing that they did _something _to help a critically ill person, esp. if the victim is a loved one.   I don't think that importance should be understated or dismissed.

What's the risk of doing compression-only CPR instead of compression with mouth-to-mouth?   Isn't the effectiveness...esp. as performed by laypeople...depressingly poor as it is?  Cardiac arrest ends up killing something like 90 percent of the times it strikes, does it not?

If this can offer a statistically similar benefit while reducing the health risks to the lay rescuer or emergency responder...then that is a positive change, IMO.


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## rlobrecht (Jul 29, 2010)

MA-Caver said:


> Besides I think a lot of people don't realize that once you've learned CPR and are current you are required to utilize it unless someone else or EMS is on the scene.



This is incorrect, at least in Texas according to my last CPR/AED instructor.  According to her, the only requirement is to call 911, and to attempt to prevent further harm (i.e. by blocking them from traffic, etc.)  This even applies to off-duty medical professionals.  Wikipedia (I realize not everything on the internet is the truth) seems to concur for most US states.  http://en.wikipedia.org/wiki/Duty_to_rescue


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## Blindside (Jul 29, 2010)

We discussed this as part of my Wilderness First Responder class several years ago.  With not really well trained CPR providers too much time is being lost on the transition between compressions and reestablishing airway and breathing.  If it takes that person 30 seconds of compressions and then takes 10 seconds to get a breath in, circulation isn't happening 25% of the time, bad news.

If fairly rapid assistance isn't expected, like in a wilderness situation, using rescue breaths would be necessary.


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## Nomad (Jul 29, 2010)

This is how we were taught it by EMT's and first responders as part of a CERT (Community Emergency Response Team) course a couple of years ago.  I was surprised at the time, since it did replace the "traditional" method I'd learned for CPR certification many years ago.

The ABC's are still taught and relevant, however;

Airway refers to checking whether or not a person is breathing, and whether or not their airway is obstructed.  The chest compressions will help circulate air in and out of the lungs, but only if the airway is not obstructed.


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