CPR without mouth to mouth works: Study

By Dr. Ananya Mandal, MDOct 5 2010

According to a new study people who suffered cardiac arrest and received chest compressions from bystanders had higher survival rates than those given standard resuscitation that included mouth-to-mouth breathing. Figures from the American Heart Association show that around 300,000 people in the U.S. collapse each year from cardiac arrest. These can be brought on by a heart attack or other reasons, and less than one-third get CPR from bystanders. The breathing or mouth to mouth resuscitation part of CPR is a big barrier for many people, the AHA says.

This latest study shows that doing away with mouth-to-mouth breathing in favor of rapid, chest-only compressions is as effective and easier for non-medical personnel to administer. The study appears in the Journal of American Medical Association.

Michael Sayre, an associate professor of emergency medicine at Ohio State University and the lead author of an AHA paper in 2008 supporting the use of “hands-only” CPR said, “Anybody can do hands-only CPR by pushing hard and pushing fast in the center of a person's chest.” In 2007, a Japanese study showed that compression-only CPR could nearly double the survival rate among patients who had a witnessed cardiac arrest. In July, two studies, one in Washington and one in Sweden, found similar results.

The latest study to this effect was led by Bentley Bobrow at the Arizona Department of Health Services. It included 4,415 adults who collapsed following cardiac arrest from 2005 through 2009. Of those, 666 patients received conventional CPR from a bystander and 849 received chest-only compressions. The rest got no CPR. Results of survival showed that 13.3% of patients receiving chest-only compressions survived compared to 7.8% for for people getting conventional CPR and 5.2% for those receiving no CPR. The study was conducted as part of an Arizona program to improve cardiac-arrest care.

Dr. Bobrow said that encouragingly the overall rate of either type of CPR increased during the study as the state's five-year-old public-health campaign on improving cardiac-arrest care was stepped up. In 2005, the rate for both types of CPR given by bystanders was about 28%. That rose to 40% in 2009. About 76% of the CPR given in 2009 to cardiac-arrest victims was chest-only compressions. During the study, overall survival among cardiac-arrest patients rose from 3.7% in 2005 to 9.8% in 2009. He explained that the statewide campaign, called SHARE, was launched to help turn the tide on the state's drab survival statistics for cardiac arrest, which kills more than 250,000 Americans every year.

However experts warn that when the heart stops for other reasons that could be respiratory like drowning and in children, rescue breathing may still serve a purpose. In an accompanying editorial Dr. David C. Cone of Yale University School of Medicine in New Haven, Connecticut also warned that hands-only CPR did not protect the brain better than standard CPR.

Dr. Bobrow emphasized, “If someone suddenly collapses and is gasping, you need to call 911 and start pushing hard and fast on the chest, 100 times a minute…Anyone can be a life-saver.”