In a recent email from the USA, it was quoted: “In what may prove to be the biggest shift in emergency care of cardiac arrest in 40 years, cities across the country are leading a move away from the familiar practice of using mouth-to-mouth resuscitation. (Related Story: Many 911 dispatchers eliminating mouth-to-mouth) In its place, the cities are recommending simple chest compressions pushing down repeatedly on the victim’s chest – to mimic a steady heartbeat. The emergency medical directors who are behind the shift say research in Seattle and Richmond, Va, suggests it will save many lives. (Related story: People die in just a few seconds lost). The movement became a full-fledged national trend last week at a meeting of emergency medical services (EMS) medical directors from 21 of the nation’s largest cities. Doctors from a dozen cities, including New York, Los Angeles and Chicago, decided to make the switch. They join at least seven other cities that are already advising 911callers to do chest compressions without mouth-to-mouth “rescue breathing””.

This issue has received media attention in the USA following a recent meeting of EMS medical directors. There has also been a recent article in the Weekend Australian newspaper. It mainly results from a study by Dr Hallstrom and published in the Critical Care Medicine in 2000. In this study, callers to EMS reporting a cardiac arrest and did not know CPR, were asked if they wanted to be instructed on how to do CPR. Those agreeing were randomised to receive instructions over the phone to either do full CPR or just chest compressions. This is often referred to ‘dispatcher assisted CPR’. The results of the study showed that the number of survivors in each group to be similar (14.6% for compression only vs 10.4% for full CPR)

It is important to note that the findings of this study refer only to situations where no trained bystanders were performing CPR. It shows that giving minimal telephone instructions (ie compressions only) seems to be as effective in terms of survival as giving full CPR instructions over the phone. However, this study does not compare the outcomes of untrained rescuers who receive dispatcher assisted CPR with that of CPR being performed by trained rescuers.

As such, inferring that mouth to mouth is not required when doing CPR is not supported by any clinical evidence. Furthermore, it ignores other causes of cardiac arrest such as drowning, and cardiac arrest in children, where ventilation (ie mouth to mouth) is vital.

Readers should be aware that the recommendations of the EMS directors were that “compression only” CPR advice should be given to callers receiving assistance from EMS dispatchers. It did not recommend removing mouth to mouth ventilation from CPR training or practice, as has been generally presented in the media.

Futher Reading:

  1. Hallstrom AP. Dispatcher-assisted “phone” cardiopulmonary resuscitation by chest compression alone or with mouth-to-mouth ventilation. Crit Care Med 2000;28(11 Suppl):N190-N192.

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