CPR Without Mouth to Mouth Ventilation

A small body of animal and human research suggests, perhaps surprisingly, that mouth-to-mouth ventilation may not improve outcomes for patients who undergo cardiopulmonary resuscitation after out-of-hospital cardiac arrest. To test this theory, researchers in Seattle studied 520 episodes of presumed cardiac arrest in which bystanders (not trained in CPR) telephoned emergency services dispatchers. During the calls, cases were randomized, and the dispatchers provided instructions on how to perform CPR, either with chest compression alone or with chest compression plus mouth-to-mouth ventilation; callers were told to continue until the paramedics arrived.

Survival to hospital discharge was 14.6 percent among those patients who received chest compression alone, and 10.4 percent among those who received chest compression plus mouth-to-mouth ventilation (P=0.18). Dispatchers were able to complete their instructions completely in 81 percent of the former cases but in only 62 percent of the latter -- a significant difference.

Comment: In this study, untrained bystanders who performed chest compression without mouth-to-mouth ventilation were at least as effective as those who provided CPR with both maneuvers. The implications of these results are considerable, because performing mouth-to-mouth ventilation makes CPR more complicated and deters some people from wanting to do CPR at all. Whether these results would hold for CPR done by rigorously trained people is unclear. In any case, an editorialist -- a CPR researcher -- states that this report is "of immense importance and will have worldwide implications."

AS Brett

Published in Journal Watch Dermatology August 1, 2000
Originally published in Journal Watch June 9, 2000

Source

Hallstrom A et al. Cardiopulmonary resuscitation by chest compression alone or with mouth-to-mouth ventilation. N Engl J Med 2000 May 25 342 1546-1553.

Ewy GA. Cardiopulmonary resuscitation -- strengthening the links in the chain of survival. N Engl J Med 2000 May 25 342 1599-1601.