CPR Without Mouth-to-Mouth Is Also Effective

From the WebMD Archives

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 well.

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 training.

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.

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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 WebMD.

"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 Minnesota.

Kaye, who reviewed the study for WebMD, agrees with Hallstrom that people who are hesitant to perform CPR should at least do chest compressions. "If the difference is between not doing CPR at all and doing CPR with chest compression only, clearly I would rather see something done that, to the best of our knowledge, appears to be good, rather than doing nothing before care arrives, which we know is bad," Kaye says.

Kaye adds that instruction for emergency medical staff who are trained by Regions Hospital may change based on this study. Region's dispatchers already give CPR instruction if callers agree to do it, but they only provide direction for standard CPR -- mouth breathing plus chest compression. "If we can show that the easy way works as well as the hard way, then we would adjust for that," Kaye says.

While praising the study, a spokesman for the American Heart Association says more research is needed before the organization can embrace the concept that anything other than standard CPR should be practiced or taught.

"We have been evaluating the different studies that have come forward, and the final conclusion is that it is advisable to continue teaching the full form of CPR," says Jerry Potts, PhD, director of science for the association's emergency cardiovascular care programs. "The heart association has been really trying to identify ways to simplify how we teach CPR. The ultimate goal is for everyone to know CPR and be willing to do it."

An official with the American Red Cross was also hesitant to discuss any practical applications of the study's findings. "We are definitely interested and excited about it, if it is something that can save lives," says Connie Harvey, a health and safety expert with the Red Cross. She adds that she is eager to see whether the findings are embraced by emergency medicine experts, which will determine whether any changes are made to Red Cross CPR programs and guidelines.

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