CPR for the Squeamish

For disease-fearful bystanders, there's an alternative to traditional mouth-to-mouth technique in heart attack cases

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HealthDay Reporter

SATURDAY, Oct. 27, 2001 (HealthDayNews) -- Too many people view the "kiss of life" as a kiss of death.

In an age when fear of disease is widespread, many Americans are reluctant to perform mouth-to-mouth resuscitation in an emergency.

One survey by the University of Arizona College of Medicine found that only 15 percent of respondents would be willing to perform the mouth maneuver that forces air into the lungs of a stricken stranger.

That's bad news for heart attack victims, who are twice as likely to die without effective cardiopulmonary resuscitation, or CPR, from bystanders.

Now the American Heart Association (AHA) is recommending that 911 emergency dispatchers be trained to instruct reluctant bystanders in a type of CPR that involves no mouth contact.

"Something is better than nothing. That's the key," says Ed Stapleton, a paramedic, EMS trainer and assistant professor of emergency medicine at the State University of New York at Stony Brook.

Coronary heart disease is the largest killer in America. In 1998, the most recent year for which statistics are available, it caused almost 460,000 deaths.

More to the point: on average, two Americans suffer a heart attack every minute -- and one of them dies.

The new rescue technique, called compression-only CPR, involves pushing down on the victim's chest to force air into the lungs.

Researchers believe that compression alone can help a heart attack victim survive for three to five minutes -- long enough, hopefully, for emergency medical services to arrive.

And because the procedure bypasses the mouth-to-mouth contact, bystanders may be more willing to perform it.

"We would prefer that you do everything," says Dr. Ed Racht, medical director for the City of Austin/Travis County Emergency Medical Services in Texas. "But our message is: If it's chest compressions or nothing at all, then please do compressions."

Compression-only CPR also is easier for untrained bystanders to perform. In the chaos of an emergency, bungled attempts at mouth-to-mouth sometimes can make a bad situation worse.

"The lay public has a hard time ventilating properly," says Robert Marschall, a paramedic/firefighter who is the training officer for the Hillsborough County Fire Rescue in Tampa, Fla.

"They may get too much air into the stomach. Then we have vomiting, and then we have a worse problem," he says.

Marschall and other experts stress that chest compression combined with mouth-to-mouth, properly administered, is still widely accepted as the most effective form of assistance for cardiac victims.

"If you're doing compression-only CPR, you're not moving air in and out of the lungs and you're not providing additional oxygen," says Stapleton.

But at least one study, in Seattle, found similar survival rates for victims in cases when bystanders were coached through traditional CPR and when they were coached through the compression-only technique.

Compression-only CPR has its limits, also. It is not effective on victims of trauma or drowning -- only on heart-attack victims.

And because the technique only works for a few minutes, it may not be suitable for use in places where emergency response is slow -- for instance, in rural areas where the nearest ambulance might be at least 15 minutes away.

Don't expect to see classes in compression-only CPR from your local Red Cross or scout troop, either. The Heart Association isn't recommending that the technique be taught to the public as a replacement for traditional CPR.

"What we don't want to do is promote the idea that all you need to do is compression," says Racht. "I wouldn't want that for my family or my kids."

But when an emergency dispatcher has a panicked bystander on the phone, and the person is either unable or unwilling to perform mouth-to-mouth, then the compression-only technique gives the dispatcher another option.

"In essence, instead of being an on/off switch, the new philosophy is more of a dimmer switch," Racht says.

What To Do

Because the AHA doesn't want to push the compression-only method at the expense of traditional CPR, the association is only instructing emergency dispatchers how to perform the technique.

Check this Amherst College Emergency Medical Services site for a primer on how to perform CPR. To find CPR classes near you, visit this American Heart Association Web page.

SOURCES: Interviews with Robert Marschall, training officer, Hillsborough County Fire Rescue, Tampa, Fla.; Ed Racht, M.D., medical director, City of Austin/Travis County Emergency Medical Services; Ed Stapleton, assistant professor of emergency medicine, State University of New York at Stony Brook, New York

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