Transmission of infectious diseases through mouth-to-mouth ventilation: evidence-based or emotion-based medicine?

Abstract

UpdateCardiopulmonary arrest is the interruption of the heart's mechanical activity confirmed by unconsciousness, apnea, and absence of central pulse 1 . The basic technical knowledge for management of this medical emergency by way of cardiopulmonary resuscitation (CPR) should be part of the training curriculum for health care workers and is highly recommended for the general public. However, concern about the transmission of diseases appears to have created substantial barriers for the use of CPR, both in and out of the hospital setting. The idea that the intention of saving a person's life could result in the death of the rescuer is intimidating and reduces peoples' desire and availability to help cardiopulmonary arrest victims [2][3][4][5] . The outcome of reduced use of CPR is reflected in the increase in the morbidity and mortality of the event 6-8 . Studies carried out by Brenner report that about 50% of physicians would refuse to carry out mouth-to-mouth ventilation in strangers and 7-14% would not perform mouth-to-mouth ventilation on victims with AIDS [9][10][11] . Another study reports that, although 68% of the interviewees would perform chest compressions on an unknown victim of cardiopulmonary arrest, only 15% would perform mouth-to-mouth ventilation 12 . A number of other papers report similar findings [13][14][15][16][17] . In the great majority of cases, the reason for the reluctance to immediately start CPR is the fear of catching transmissible diseases, especially HIV 12,18 . The objective of this article is to review the literature on infectious diseases transmitted through mouth-tomouth ventilation. The search for available scientific evidence for pre-and post-exposure prophylaxis has been made through searching the Medline database of articles published between 1990-1999. In addition to this, all the articles published between 1966-1999 in journals indexed to Index Medicus with the key word mouth to mouth ventilation or mouth-to-mouth ventilation, and cardiopulmonary resuscitation were reviewed. Conclusions were also based on a personal collection of articles, posters and relevant notes collected over the last few years.

O leigo e o suporte básico de vida

“…Although CPR is deemed as a safe, effective technique capable of saving lives, many rescuers fail in performing CPR due to fear of acquiring infectious-contagious diseases by means of mouth-to-mouth respiration (3,9,10) . In fact, several infectious diseases can be transmitted during any mouth-to-mouth contact, but in spite of the transmissibility potential, literature records very rare cases of effective contagious processes during the execution of CPR maneuvers in over 250 years (10) .…”

“…In fact, several infectious diseases can be transmitted during any mouth-to-mouth contact, but in spite of the transmissibility potential, literature records very rare cases of effective contagious processes during the execution of CPR maneuvers in over 250 years (10) .…”

“…Besides, compression without ventilation makes BLS sequence simpler, facilitating learning, assimilation, and performance (11) . With no regard to the importance of artificial ventilation during the resuscitation maneuver, rescuers who would not be willing to perform it must trigger, in an immediate basis, an ETC process in the occurrence of a CPR, so that assistance is not endangered (2,8,(10)(11)(12)17) .…”

Viral Diseases Transmissible by Kissing

“…105 No case of transmission by HCV after mouth-to-mouth ventilation has been described. 106 Transmission of HCV in CPR using CPR mannequins has not been reported even when exposed to HCV-contaminated saliva. 107 Saliva may therefore be a source of occasional transmission of HCV, 108 particularly where there is deep kissing and there are oral mucosal lesions 109 though epidemiological studies suggest that the infective capacity of HCV in saliva is only low.…”

Cardiopulmonary resuscitation, chest compression only, and teamwork from the perspective of medical doctors, surgeons and anesthesiologists

“…Disease transmission is only occasionally reported after CPR (7,8). In a meta-analysis from year 1998, Mejicano and Maki found that only 15 documented cases, mainly bacterial infections, were reported after mouthto-mouth ventilation.…”