Experts Move to Resuscitate CPR

Skip the mouth-to-mouth, they say, especially if you're untrained

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By
HealthDay Reporter

MONDAY, June 7, 2004 (HealthDayNews) -- Suppose you're on the subway, in the mall or at the market, and you keel over with a heart attack or other crisis that renders you unconscious.

Here's some cruel but accurate news: Don't expect the whole world to come to your rescue.

In fact, your chances of getting a bystander to use life-saving cardiopulmonary resuscitation (CPR) on you are a dismal one-in-five, said Dr. Gordon A. Ewy, a veteran CPR researcher who is chief of cardiology at the University of Arizona College of Medicine in Tucson.

Those odds become even worse when you consider that only 20 years ago up to 60 percent of bystanders would have performed the mouth-to-mouth rescue breathing, said Ewy, citing published studies.

Regardless of what might be driving the reluctance by bystanders to perform CPR -- fear of disease, fear of lawsuits -- there is a simple solution, Ewy said. Switch to what he calls the "new" CPR -- chest compression-only CPR, in which the mouth-to-mouth breathing steps are skipped when done by untrained people.

Ewy is not alone in his thinking. Across the country, a growing number of emergency system dispatchers are instructing frantic callers who want to save someone who has stopped breathing to skip the mouth-to-mouth step, too.

"The single most important thing is the chest compressions," said Dr. Paul Pepe, medical director of the City of Dallas Emergency Medical Services.

Pepe, who is also chairman of emergency medicine at the University of Texas Southwestern Medical Center, helped organize other physicians who are medical directors of emergency medical services for large cities nationwide. At a conference this spring, the group, informally known as the "Gathering of Eagles," decided that the chest-only method is best for untrained people.

Among the cities that are switching over to the new technique are Chicago; Dallas; Los Angeles; New York City; Philadelphia; Richmond, Va.; San Francisco; and Seattle.

While mouth-to-mouth is still taught in formal CPR classes, Pepe, Ewy and others say valuable life-saving time is wasted with 911 dispatchers trying to explain to untrained people how to do both the breathing steps and the chest compressions.

In Tucson, where Ewy is director of the university's Sarver Heart Center, he and his team have mailed informational fliers about the new CPR to make the public more aware of it -- and to alert them that it is not just life-saving, but can save more lives when performed by untrained members of the public.

"We have sent these fliers to every household in Tucson with their electric bill," Ewy said. Other cities have contacted him to follow suit, he added.

Since 2000, the American Heart Association has recommended compression-only CPR when the rescuer is unwilling or unable to perform mouth-to-mouth rescue breathing. But that practice wasn't widely adopted, Pepe said.

Study after study has shown that compression-only CPR results in better survival when untrained bystanders are performing it.

"We demonstrated in 1993 that chest compression only was as good as ideal CPR in which you do 15 compressions and two quick breaths," said Ewy, referring to animal studies his team conducted.

In a study published in May 2000 in the New England Journal of Medicine, University of Washington researchers analyzed the results for 241 patients who got chest-compression-only CPR and 279 who received mouth-to-mouth along with chest compressions when treated at the scene. Survival rates up to the time of hospital discharge were better among the compression-only group: 14.6 percent survived, compared to 10.4 percent of those who also got mouth-to-mouth.

In another study, published last fall in Resuscitation, researchers from England compared the results of 29 people told to give chest-compression-only CPR to a training mannequin with 30 who gave compression plus mouth-to-mouth to a mannequin. They found compression-only rescuers were able to administer two and a half times as many compressions during the time it normally takes an ambulance to arrive.

Just as important, an earlier study by Ewy showed that people were simply more comfortable performing compression-only CPR on someone they didn't know.

A survey of more than 4,000 people showed that "15 percent would do CPR if they had to do mouth-to-mouth, too," he said. "Sixty-eight percent would do chest compressions only."

In compression-only CPR, you position the victim on his back on the floor. Then you put one hand on top of the other, placing the heel of the bottom hand on the center of the victim's chest. Lock your elbows and begin chest compressions at a rate of 100 per minute, Ewy said.

If an automated external defibrillator, a device to help restore the heart's natural rhythms, is available, attach it and follow instructions. If it is not available, continue the compressions until emergency help arrives.

More information

To learn more about CPR, visit the American Heart Association.

SOURCES: Paul Pepe, M.D., M.Ph.H. professor and chairman, emergency medicine, University of Texas Southwestern Medical Center at Dallas; Gordon A. Ewy, M.D., professor, chief, cardiology section, and director, Sarver Heart Center, University of Arizona, Tucson

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