Canadian Red Cross
has no plans to drop mouth-to-mouth from CPR training
Photo courtesy of Canadian
Red Cross
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Over a million Canadians are trained
each year in cardiopulmonary resuscitation (CPR). There's
no doubt that a bystander's intervention can save lives:
the odds of survival for a victim of cardiac arrest
are almost four times greater if someone performs CPR
right away, according to the Heart and Stroke Foundation
of Canada. But new research is suggesting basic CPR
training may be fatally flawed.
Surveys have shown that many people
are put off by the idea of mouth-to-mouth. As a result,
some experts have suggested that a simplified form of
CPR, involving just chest compressions (cardiac-only
CPR), would improve intervention rates and save extra
lives. Others go even further, arguing that cardiac-only
CPR is better because it avoids the problem of stomach
insufflation and allows more compressions per minute.
A
BAD SCENE
A new study in the Lancet appears to support
this conclusion. The SOS-KANTO study looked at out-of-hospital
cardiac arrests in the Kanto region of Japan, drawing
data from paramedics operating out of 58 emergency hospitals
and clinics over 15 months.
Nearly 10,000 resuscitations were
attempted during the study period. Of the 4,068 witnessed
cases that were included, bystanders either performed
no attempted resuscitation (2,917 cases), standard CPR
(712 cases), or cardiac-only CPR (439 cases), according
to data gathered by paramedics when they arrived on
scene.
Out-of-hospital cardiac arrest
is so catastrophic that the vast majority of patients
in all treatment categories never made it. The researchers
didn't even relate the death rate among patients who
received no bystander resuscitation. They merely note
that it was far worse than among those who did get CPR
— of whom a mere 8% survived.
Of that 8%, nearly half had a poor
neurological outcome at 30 days, due to oxygen starvation
in the brain. But that's where the rates between the
two types of CPR differed. Among the whole cohort, the
difference was not statistically significant, but in
key categories of patients who stood a realistic chance
of survival — those with apnea, ventricular fibrillation
or tachycardia as initial cardiac rhythm, and patients
whose resuscitation began within four minutes of collapse
— cardiac-only CPR seemed to protect against neurological
damage.
Astonishingly, the study also uncovered
that although more than twice as many patients received
CPR from bystanders who were off-duty medical staff
than from trained members of the public, the biggest
single category of CPR giver was the completely untrained
bystander. In half of these cases, the bystander was
coached over the telephone by emergency staff.
DON'T
HOLD YOUR BREATH
The debate over mouth-to-mouth resuscitation is not
a new one. Every five years, the International Liaison
Committee on Resuscitation (ILCOR) revises CPR guidelines.
The most recent version — on which the current
Canadian guidelines are based — was published in
2005. Despite a push for cardiac-only resuscitation,
ILCOR decided to increase the number of compressions
between breaths from 15 to 30. Though compressions may
be enough in cases of primary cardiac arrest due to
heart attack, they argued, they aren't sufficient in
cases of cardiac arrests due to drowning, drug overdose,
asphyxiation, head trauma, and various kinds of suicide
attempts, in which respiratory failure caused the heart
to stop.
Dr Andrew Travers, director of
emergency medical services for Nova Scotia and a spokesman
for the Heart and Stroke Foundation of Canada, is a
member of ILCOR. He said the KANTO study will be carefully
looked at, but its recommendations are certainly not
going straight into the 2010 guidelines. "It's a big
study, but it has flaws. It's not a randomized, controlled
trial, nor is it population-based. But above all, the
conventional CPR method used [based on the 2000 guidelines]
was out of date."
Emergency medicine specialists
all agree that whether bystanders perform mouth-to-mouth
or not, doing anything is better than doing nothing.
Even an untrained layperson can make a difference by
copying what they've seen on TV. Once the heart stops
pumping, seconds count — for every minute that
passes without help, a victim's chance of surviving
drops by about 10%.
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