Friday, March 16, 2007

Skip the Kiss of Life


The term "kiss of life" is taken from a BBC News article I talk about below. For those in the United States, it is better known as mouth-to-mouth resuscitation. I put the Trump/Rosie picture up there so that you could probably make up a funnier line than I could. HA!

Anyway, according to the American Heart Association, in their Adult Basic Life Support course, the first step is always to assess the airway and breathing. If the person is not found to be breathing, this is what you're supposed to do:
Give 2 rescue breaths, each over 1 second, with enough volume to produce visible chest rise. This recommended 1-second duration to make the chest rise applies to all forms of ventilation during CPR, including mouth-to-mouth and bag-mask ventilation and ventilation through an advanced airway, with and without supplementary oxygen (Class IIa recommendation).

During CPR the purpose of ventilation is to maintain adequate oxygenation, but the optimal tidal volume, respiratory rate, and inspired oxygen concentration to achieve this are not known. The following general recommendations can be made:

1. During the first minutes of VF [ventricular fibrillation] SCA [sudden cardiac arrest], rescue breaths are probably not as important as chest compressions because the oxygen level in the blood remains high for the first several minutes after cardiac arrest. In early cardiac arrest, myocardial and cerebral oxygen delivery is limited more by the diminished blood flow (cardiac output) than a lack of oxygen in the blood. During CPR blood flow is provided by chest compressions. Rescuers must be sure to provide effective chest compressions and minimize any interruption of chest compressions.

2. Both ventilations and compressions are important for victims of prolonged VF SCA, when oxygen in the blood is utilized. Ventilations and compressions are also important for victims of asphyxial arrest, such as children and drowning victims who are hypoxemic at the time of cardiac arrest.

3. During CPR blood flow to the lungs is substantially reduced, so an adequate ventilation-perfusion ratio can be maintained with lower tidal volumes and respiratory rates than normal. Rescuers should not provide hyperventilation (too many breaths or too large a volume). Excessive ventilation is unnecessary and is harmful because it increases intrathoracic pressure, decreases venous return to the heart, and diminishes cardiac output and survival.

4. Avoid delivering breaths that are too large or too forceful. Such breaths are not needed and may cause gastric inflation and its resultant complications.
Now, Japanese researchers published in The Lancet showed that chest-compression-only resuscitation is adequate without mouth-to-mouth resuscitation. (BBC news)
Dr Ken Nagao and colleagues at the Surugadai Nihon University Hospital in Tokyo say in these circumstances it would be better for all parties to stick to giving chest compressions alone, which they called cardiac-only resuscitation. They checked their theory by looking at the outcomes of more than 4,000 adult patients who had been helped by bystanders.

They found chest-compression-only resuscitation was the clear winner compared with conventional CPR (cardiopulmonary resuscitation, or mouth-to-mouth breathing together with chest compressions).
The Resuscitation Council in the United Kingdom agrees with this statement and has made these changes in their Adult Basic Life Support guidelines:
To aid teaching and learning, the sequence of actions has been simplified. In
some cases, simplification has been based on recently published evidence; in
others there was no evidence that the previous, more complicated, sequence had
any beneficial effect on survival.

There are other changes in the guidelines. In particular, allowance has been
made for the rescuer who is unable or unwilling to perform rescue breathing. It is
well recorded that reluctance to perform mouth-to-mouth ventilation, in spite of
the lack of evidence of risk, inhibits many would-be rescuers from attempting any
form of resuscitation. These guidelines encourage chest compression alone in
such circumstances.
Who's right and who's wrong here? Does it really matter? Is there a "right" way to administer CPR? In this age of evidence based medicine, I'm sure that there will be more studies done to bolster the case of both sides.

I do agree that people these days are less inclinced to perform mouth-to-mouth. I mean, there are some who would rather perform mouth-to-muzzle rescue breathing (just kidding).

If anything else, a news story like this puts CPR in the spotlight. So, whatever you think about mouth-to-mouth resuscitation, if you've never been taught the concepts of Basic Life Support, get out there and learn about CPR! You may save a friend or family or even a complete stranger one of these days.

4 comments:

the night owl said...

Dr. Your statement is new to me, regarding chest compressions only.Is the rule on this changing ?I retired from nursing three years ago and would love to know? I need a new CPR
class.I will be back to follow your
blog. thanks, Baba

Chrysalis Angel said...

Interesting Dr.A. Did you know they are now using special face masks for animals? Seriously, our F.D. has used rescued breathing and saved many an animal on a fire scene.

It's me, T.J. said...

I truly believe that there would be more "good samaritans" if they knew they didn't have to perform m2m. Mostly because of, you know, ~germs~.

BTW...

You've been tagged...

by me.

later...

doc said...

i read this with surprise when it was mentioned in the local press. although this new finding challenges the basic tenets of CPR which has been successfully implemented & expedited for decades, i feel that this new technique is good only for the 1st few minutes of resuscitation. after that time, you really need oxygenated blood for the brain & you can only achieved that with a mouth-to-mouth, ambu bagging with a face-mask or ETT.

just my 2 cents' worth.