Bystander cardiopulmonary resuscitation: Concerns about mouth-to-mouth contact

Locke, CJ; Berg, RA; Sanders, AB; Davis, M.F.; Milander, MM; Kern, KB; Ewy, G A

doi:10.1016/0300-9572(96)83764-6

Cited by 24 publications

(36 citation statements)

References 3 publications

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“…Low rates of bystander CPR may be due to several factors, including lack of prior CPR instruction, fear of communicable disease, or event anxiety. [13][14][15] Dispatcher-assisted bystander CPR is one means to address these obstacles. On the basis of our experience, dispatcher-assisted bystander CPR is associated with a 25% absolute increase in the proportion of arrest victims who receive bystander CPR (30% to 55%).…”

Section: Discussionmentioning

confidence: 99%

Dispatcher-Assisted Cardiopulmonary Resuscitation and Survival in Cardiac Arrest

et al. 2001

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Background-Early cardiopulmonary resuscitation (CPR) improves survival in out-of-hospital cardiac arrest, and dispatcher-delivered instruction in CPR can increase the proportion of arrest victims who receive bystander CPR before emergency medical service (EMS) arrival. However, little is known about the survival effectiveness of dispatcherdelivered telephone CPR instruction. Methods and Results-We evaluated a population-based cohort of EMS-attended adult cardiac arrests (nϭ7265) from 1983 through 2000 in King County, Washington, to assess the association between survival to hospital discharge and 3 distinct CPR groups: no bystander CPR before EMS arrival (no bystander CPR), bystander CPR before EMS arrival requiring dispatcher instruction (dispatcher-assisted bystander CPR), and bystander CPR before EMS arrival not requiring dispatcher instruction (bystander CPR without dispatcher assistance

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Section: Discussionmentioning

confidence: 99%

Dispatcher-Assisted Cardiopulmonary Resuscitation and Survival in Cardiac Arrest

et al. 2001

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“…Although this approach has resulted in survival rates of 25% to 30% in Seattle, dismal survival rates of Ͻ5% are generally reported elsewhere. [1][2][3] One contributing factor to the very low survival rates in 3 relatively recent studies may be the disappointingly low rates of bystander-initiated CPR: 16%, 28%, and 22%. [1][2][3] Although the reasons for such low bystander CPR rates are not fully known, mouth-to-mouth rescue breathing is apparently a barrier to the performance of bystander CPR.…”

mentioning

confidence: 99%

“…[1][2][3] One contributing factor to the very low survival rates in 3 relatively recent studies may be the disappointingly low rates of bystander-initiated CPR: 16%, 28%, and 22%. [1][2][3] Although the reasons for such low bystander CPR rates are not fully known, mouth-to-mouth rescue breathing is apparently a barrier to the performance of bystander CPR. [1][2][3][4] Numerous animal investigations and 2 clinical studies suggest that bystander CPR with chest compressions alone (CC) is as effective as chest compressions plus rescue breathing (CCϩRB) for VF cardiac arrest.…”

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confidence: 99%

Adverse Hemodynamic Effects of Interrupting Chest Compressions for Rescue Breathing During Cardiopulmonary Resuscitation for Ventricular Fibrillation Cardiac Arrest

et al. 2001

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Background-Despite improving arterial oxygen saturation and pH, bystander cardiopulmonary resuscitation (CPR) with chest compressions plus rescue breathing (CCϩRB) has not improved survival from ventricular fibrillation (VF) compared with chest compressions alone (CC) in numerous animal models and 2 clinical investigations. Methods and Results-After 3 minutes of untreated VF, 14 swine (32Ϯ1 kg) were randomly assigned to receive CCϩRB or CC for 12 minutes, followed by advanced cardiac life support. All 14 animals survived 24 hours, 13 with good neurological outcome. For the CCϩRB group, the aortic relaxation pressures routinely decreased during the 2 rescue breaths. Therefore, the mean coronary perfusion pressure of the first 2 compressions in each compression cycle was lower than those of the final 2 compressions (14Ϯ1 versus 21Ϯ2 mm Hg, PϽ0.001). During each minute of CPR, the number of chest compressions was also lower in the CCϩRB group (62Ϯ1 versus 92Ϯ1 compressions, PϽ0.001). Consequently, the integrated coronary perfusion pressure was lower with CCϩRB during each minute of CPR (PϽ0.05 for the first 8 minutes). Moreover, at 2 to 5 minutes of CPR, the median left ventricular blood flow by fluorescent microsphere technique was 60 mL · 100 g Ϫ1 · min Ϫ1 with CCϩRB versus 96 mL · 100 g Ϫ1 · min Ϫ1 with CC, PϽ0.05. Because the arterial oxygen saturation was higher with CCϩRB, the left ventricular myocardial oxygen delivery did not differ. Conclusions-Interrupting chest compressions for rescue breathing can adversely affect hemodynamics during CPR for

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“…[1][2][3] One reason postulated for this decline in bystander CPR is lay rescuer reluctance to administer mouth-to-mouth breathing. 4,5 The American Heart Association has called for simplification as a central educational theme in efforts to encourage more bystander participation. 6 One dramatic step toward simplification is to eliminate mouth-to-mouth ventilation for lay rescuers.…”

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confidence: 99%

Importance of Continuous Chest Compressions During Cardiopulmonary Resuscitation

et al. 2002

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Background — Interruptions to chest compression–generated blood flow during cardiopulmonary resuscitation (CPR) are detrimental. Data show that such interruptions for mouth-to-mouth ventilation require a period of “rebuilding” of coronary perfusion pressure to obtain the level achieved before the interruption. Whether such hemodynamic compromise from pausing to ventilate is enough to affect outcome is unknown. Methods and Results — Thirty swine (weight 35±2 kg) underwent 3 minutes of untreated ventricular fibrillation before 12 minutes of basic life support CPR. Animals were randomized to receive either standard airway (A), breathing (B), and compression (C) CPR with expired-gas ventilation in a 15:2 compression-to-ventilation ratio or continuous chest compression CPR. Those randomized to the standard 15:2 group had no chest compressions for a period of 16 seconds each time the 2 ventilations were delivered. Defibrillation was attempted at 15 minutes of cardiac arrest. All resuscitated animals were supported in an intensive care environment for 1 hour, then in a maintenance facility for 24 hours. The primary end point of neurologically normal 24-hour survival was significantly better in the experimental group receiving continuous chest compression CPR (12 of 15 versus 2 of 15; P <0.0001). Conclusions — Mouth-to-mouth ventilation performed by single layperson rescuers produces substantial interruptions in chest compression–supported circulation. Continuous chest compression CPR produces greater neurologically normal 24-hour survival than standard ABC CPR when performed in a clinically realistic fashion. Any technique that minimizes lengthy interruptions of chest compressions during the first 10 to 15 minutes of basic life support should be given serious consideration in future efforts to improve outcome results from cardiac arrest.

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Bystander cardiopulmonary resuscitation: Concerns about mouth-to-mouth contact

Cited by 24 publications

References 3 publications

Dispatcher-Assisted Cardiopulmonary Resuscitation and Survival in Cardiac Arrest

Dispatcher-Assisted Cardiopulmonary Resuscitation and Survival in Cardiac Arrest

Adverse Hemodynamic Effects of Interrupting Chest Compressions for Rescue Breathing During Cardiopulmonary Resuscitation for Ventricular Fibrillation Cardiac Arrest

Importance of Continuous Chest Compressions During Cardiopulmonary Resuscitation

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