WEDNESDAY, APRIL 7, 2004 (HealthDayNews) -- The 9-1-1 dispatcher's instructions can seem overwhelming if you aren't trained in cardiopulmonary resuscitation (CPR) and are struggling to save someone who has stopped breathing.
So emergency medicine experts now suggest dispatchers tell untrained callers to skip the mouth-to-mouth part of CPR and proceed directly to chest compressions.
"The single most important thing is the chest compressions," said Dr. Paul Pepe, medical director of the City of Dallas Emergency Medical Services and professor and chairman of emergency medicine at the University of Texas Southwestern Medical Center.
Pepe helped organize a group of physicians who, like himself, are medical directors of emergency medical services for large cities nationwide. At a conference last month, the group -- informally called a "Gathering of Eagles" -- decided "this is the best way" for people untrained in CPR to save lives, Pepe said.
Among the cities represented at the meeting, he said, were Chicago, Dallas, Los Angeles, New York, Philadelphia, Richmond, Va., San Francisco and Seattle.
Chest compressions involve pushing down repeatedly on the chest to mimic a steady heartbeat.
As the medical directors implement the new approach in their respective cities, it will mean that when people call 9-1-1 for help in a medical emergency, the dispatcher may skip directly to the chest compression instructions, Pepe said.
"We're not giving up on mouth-to-mouth," Pepe said. The technique is still taught as part of CPR classes. But when people call 9-1-1 to report a heart attack, breathing problems or other medical emergencies, Pepe said, many are not trained or are too nervous to remember their CPR training.
"It takes too long to explain mouth-to-mouth," he said.
Since September 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 it wasn't widely adopted," Pepe said.
But at the recent conference, Pepe said, most medical directors agreed that compression-only CPR is best for untrained or nervous rescuers.
The approach makes sense from a medical point of view, Pepe said.
In a May 2000 study published in the New England Journal of Medicine, University of Washington researchers analyzed the results for 241 patients who got chest compression alone, versus 279 people who received both chest compression and mouth-to-mouth from bystanders at the scene. The survival rates to hospital discharge were better among those who received chest compression only.
The researchers concluded that chest compression alone "may be the preferred approach for bystanders inexperienced in CPR."
Another study, published in the October 2003 issue of Resuscitation, came up with similar results. Researchers from England compared the results of 29 people told to give chest compression only to a training mannequin with 30 people who gave compression plus mouth-to-mouth to a mannequin. They found the 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.
The researchers concluded that eliminating the rescue breathing for inexperienced rescuers would have little impact on rescue efforts.
"It's common sense versus dogma," said Dr. Wally Ghurabi, medical director of the Emergency Center at Santa Monica-UCLA Medical Center in California. "If the rescuer is well-trained, [he or she can] go ahead and give mouth-to-mouth.
If not, the compression-only instructions are better, he said.
But Ghurabi urged all people to take a CPR class. "Every three to five years, go get re-certified," he advised. The investment of time -- a few hours -- is modest, he said, compared to the potential payoff of saving someone's life.
More than 6 million people a year get CPR training from the American Heart Association.
A new study just published this week also finds that bystanders aren't the only ones with something to learn about CPR. Some emergency health-care workers may be too aggressive when they administer the technique. The result: People who suffer cardiac arrest may be dying because EMTs are trying too hard to get the blood flowing again.
Dr. Tom P. Aufderheide and his colleagues at the Medical College of Wisconsin looked at how seven cardiac arrest patients were given CPR. They found the ambulance crews were creating a ventilation rate of 37 breaths a minute, far above the 12-to-15-breath-a-minute pace recommended by the American Heart Association. A report on the study appears in the April 6 issue of Circulation.
That excessive rate might be one reason survival rates for cardiac arrest patients remain "dismal," with only one of every 20 surviving, said Aufderheide, a professor of emergency medicine.
Although it was a small study, the researchers said it's possible the same thing could be occurring across the United States. Aufderheide suggested that emergency personnel get special training to keep their compression rate within the recommended level.
More information
The American Heart Association has more on CPR, as well as guidelines for the rescue approach.
