WebMD Health News
Daniel J. DeNoon
Louise Chang, MD
March 16, 2007 -- For adults who suddenly collapse, CPR is more effective if
rescuers focus on chest compression over mouth-to-mouth ventilation.
CPR stands for cardiopulmonary resuscitation. It's used on people whose
hearts suddenly stop beating. Using this emergency technique, you can keep a
person alive until professional help arrives.
Currently, CPR includes two techniques. The first is mouth-to-mouth
resuscitation, the so-called breath of life. The other is chest compression:
pushing down hard on a victim's chest, more than once a second, pressing it
down at least an inch and a half before releasing.
A major reason why bystanders don't give CPR to people who suddenly collapse
is reluctance to put their mouths on the mouth of a stricken person. That
reason no longer exists.
Now, for adults who suddenly collapse, there's powerful evidence that chest
compression alone is far better than doing nothing. In fact, the new evidence
suggests that by interrupting lifesaving chest compressions, mouth-to-mouth
resuscitation may do more harm than good.
The striking evidence comes from Ken Nagao, MD, of Surugadai Nihon
University Hospital in Tokyo, and colleagues. The researchers took a careful
look at what happened to 4,068 adults who had an out-of-hospital cardiac arrest
witnessed by bystanders.
More than 70% of the time, the bystanders did nothing when a person suddenly
collapsed. Those victims were less likely to survive, and more likely to have
brain damage if they did survive, than when bystanders tried to do
Bystanders bravely gave traditional CPR to 18% of victims. And those
patients did much better than those who got no bystander aid.
But victims were 2.2 times less likely to suffer brain damage if they were
among the 11% of patients who got chest compressions only -- without
The findings appear in the March 17 issue of the journal The
"This study just confirms what has pretty much become common
knowledge," CPR researcher Alfred Hallstrom, PhD, of the University of
Washington in Seattle, tells WebMD. "We did a randomized trial of
compressions vs. CPR, and the results indicated that the compression-only
technique was better. Subsequently, labs have done animal studies suggesting
the same thing."
"This does not surprise me one bit," CPR researcher Joseph W.
Heidenreich, MD, of Texas A&M Health Science Center, tells WebMD. "This
is what all of us who have done CPR research have suspected for years. This is
amazing data. Primarily, what people who suffer cardiac arrest need are chest
But not everyone is willing to give up on teaching people to give
mouth-to-mouth resuscitation. One of them is Lance Becker, MD, director of the
center for resuscitation science at the University of Pennsylvania and past
chair of the basic life support subcommittee of the American Heart Association
"The real message from this study is that doing something is better for
saving people's lives than doing nothing," Becker tells WebMD. "Good
compressions are associated with good things. It does not mean that ventilation
is not an excellent thing as well."
Becker says the AHA has always said that if people feel uncomfortable doing
mouth-to-mouth resuscitation, they should simply focus on chest compression.
And he says the new study validates this approach.
Charles Sea, MD, an emergency-room physician at Ochsner Medical Center in
New Orleans, teaches CPR to doctors. He says that new CPR techniques emphasize
chest compressions over mouth-to-mouth ventilation.
"We are implementing new standards for faster, stronger chest
compressions -- 100 a minute, and only about six to eight breaths a
minute," Sea tells WebMD. "Compared to the old CPR, just doing
compressions would get better results. But I bet if they did the new CPR with
the fast compression and minimal ventilation, they would get even higher
survival rates than with compression alone."
But mouth-to-mouth resuscitation steals precious time from chest
compression, argues Gordon A. Ewy, MD. Ewy is director of the Sarver Heart
Center and professor and chief of cardiology at the University of Arizona
College of Medicine in Tucson.
"If you witness an adult collapse, it is most likely to be a cardiac
arrest," Ewy says. "In cardiac arrest, the blood is fully oxygenated.
What you need to do is press hard and fast on the chest to circulate the blood.
This circulation you get from pushing on the chest is barely enough to keep the
brain alive. If you stop for anything, like so-called 'rescue breathing,' which
is an oxymoron, it is not good."
The main reason why the AHA teaches mouth-to-mouth resuscitation is that
some people go into cardiac arrest because they have not been getting
sufficient air. Such patients include drowning victims, for example, and
victims of drug overdose. These patients do not have enough oxygen in their
blood, and truly need mouth-to-mouth resuscitation.
But the vast majority of people who collapse have been breathing normally
before their hearts stopped. That means that they have enough oxygen in their
blood to survive until medical help arrives -- if someone gives them continuous
chest compressions, Heidenreich says.
Heidenreich notes that chest compression is not risk-free.
"With the type of force it takes to move the blood through the veins, if
you do good CPR you probably are going to break someone's ribs," he says.
"In this past week, I've done CPR several times in elderly patients in the
ER, and probably every time I have cracked a rib. But if you talk to most
people -- and I have surveyed many -- most are much more concerned about
contracting a disease from giving mouth-to-mouth than about breaking a rib to
save a life."
Regardless of what kind of CPR you give, the most important thing is to call
for help right away. CPR is intended only to keep a patient alive until
emergency help gets there.
And the compression-only technique applies only to adult patients. Children
are far more likely to have stopped breathing than to have suffered a sudden
cardiac arrest. This means they far more often need mouth-to-mouth
resuscitation than adults do.
Nagao, K. The Lancet, March 17, 2007; vol 369: pp 920-926. Ewy,
G.A. The Lancet, March 17, 2007; vol 369: pp 882-884. Heidenreich,
J.W. Academic Emergency Medicine, October 2006; vol 13: pp 1020-1026.
Hallstrom, A. The New England Journal of Medicine, May 25, 2000; vol
342: pp 1546-1553. Gordon A. Ewy, MD, director, Sarver Heart Center, and
professor and chief of cardiology, University of Arizona College of Medicine,
Tucson. Lance Becker, MD, director of the center for resuscitation science,
University of Pennsylvania; past chair, basic life support subcommittee,
American Heart Association. Charles Sea, MD, emergency room physician, Ochsner
Medical Center, New Orleans. Joseph W. Heidenreich, MD, teaching resident,
Texas A&M Health Science Center, Temple, Texas. Alfred Hallstrom, PhD,
professor of biostatistics, University of Washington, Seattle.
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