Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.See all posts »
Artificial Breathing in Cardiopulmonary Resuscitation (CPR)
The compression stage of CPR.Recent guidelines recommend that cardiopulmonary resuscitation (CPR) be done with compressions only, eliminating the requirement for the untrained rescuer to attempt to breathe for (ventilate) the victim. This effectively eliminates the “P” in CPR.
From the first I heard of this, the logic of this recommendation has escaped me. I understand how CPR improperly performed (e.g., with inadequate chest compressions) can be problematic. Perhaps eliminating the need to integrate rescue breaths into the routine improves the quality of chest compressions. But I fail to see how, all things being equal, providing no oxygen to a victim would be better than providing some oxygen. If all one has is the oxygen content in expired air and suboptimal breaths, that still seems to be better than nothing, so long as proper compressions are maintained. I may be bucking the fad, but forced to wager, I would bet on a long-term, well controlled study of properly-performed CPR demonstrating that rescue breathing still has a role. If the issue is training, then perhaps there is a solution.
We now begin to get an inkling of this from a study by Ogawa and his colleagues in Japan. Entitled “Outcomes of chest compression only CPR versus conventional CPR conducted by lay people in patients with out of hospital cardiopulmonary arrest witnessed by bystanders: Nationwide population based observational study” from the British Medical Journal 2011 January 27;342:c7106, this analysis showed that rates of both overall one-month survival and neurologically favorable one-month survival were higher in patients who received conventional CPR, as opposed to compression-only CPR.
When the data were explored, they revealed that the greatest benefit of conventional CPR was found in the sub-group represented by patients younger than 20 years of age who had suffered cardiac arrest from non-cardiac (non-heart) causes. This makes sense. It is fairly well known that cardiac arrest in a younger age group may be due to a disorder that causes lack of oxygen, such as asthma or drowning. So, one would expect the provision of oxygen during the resuscitation to be helpful, and the sooner the better. Furthermore, one would expect patients with primary heart problems as a cause of cardiac arrest to be less likely to be resuscitated by any means.
Who do we save with CPR? We save people when we can provide enough output from the heart to keep the vital organs functioning long enough to stabilize the victim. So, if someone’s heart ceases functioning because it is quivering, CPR works if it is effective long enough to allow the heart to be defibrillated, either spontaneously or with a machine. If someone suffers a cardiac arrest because they have drowned and lost the ability to breathe (but their heart is basically intact), then CPR will be effective if it can maintain a person long enough to receive oxygen. If someone has suffered a massive heart attack and has a floppy, useless heart muscle, CPR is unlikely to work—it is not magic.
In the backcountry, CPR is a dramatic maneuver of desperation. If you think you might ever need to do it, then please take the time to learn it properly, and try not to be an “untrained bystander.” Getting air (oxygen) into the victim may be what saves their life, particularly if they are young.
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