CPR Without Mouth-to-Mouth Is Also Effective
May 24, 2000 -- Although millions of Americans are trained in CPR, they may
hesitate to use those skills on a stranger because they fear contracting
diseases, particularly if they have to perform mouth-to-mouth resuscitation. A
new study, though, shows that skipping this step and simply using the hands to
press down on the chest of someone who has had a heart attack can work just as
For the study, published in TheNew England Journal of
Medicine, researchers at the University of Washington in Seattle studied
the survival rates of about 500 people suffering from apparent cardiac arrest.
Half were given CPR plus mouth breathing, and half received only the technique
called chest compression. The people helping the stricken patients were given
instructions over the phone by emergency dispatchers and had not had CPR
To perform chest compressions, the heel of the right hand is placed in the
center of the victim's chest, between the nipples, and the left hand is placed
on top of it. The person then repeatedly pushes down about one to two inches
until help arrives. In this study, there was virtually no difference in the
survival rates of the two groups of people; in fact, those who received chest
compressions alone did slightly better.
"If you find a stranger on the street, people are loath to do
mouth-to-mouth, and there is every evidence that chest compression alone will
be just as good," says Alfred Hallstrom, PhD, director of the Clinical
Trials Coordinating Center in Seattle, which is affiliated with the University
of Washington. Hallstrom, the lead researcher on the study, is also a professor
of biostatistics at the university. "You don't need to feel guilty if you
just do chest compressions."
This is particularly important when help is only four to six minutes away,
he says, as researchers have not studied the value of chest compressions alone
in situations where emergency assistance is slower to arrive.
Based on his findings, Hallstrom recommends giving chest compressions alone
to anyone older than 50 -- who is more likely to be stricken by a heart attack
rather than a stroke or airway blockage -- and giving chest compressions plus
mouth-to-mouth breathing to anyone under 50.
He says CPR instruction should be changed to place more emphasis on chest
compressions. "This challenges preconceived notions, but provides some
proof that the challenge is realistic. I think people need to think rationally
and carefully about the process" of teaching and performing CPR, he tells
"This is actually a very important study, although its scope is limited
to areas where there is a short response time," says Koren Kaye, MD,
co-director emergency medical services at Regions Hospital in St. Paul, Minn.,
and an assistant professor of clinical emergency medicine at the University of