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Thursday, May 30, 2013

Revisiting the need for rescue breathing

Let’s set the scene. A person who is not at the hospital suffers a cardiac arrest. A bystander with limited or no medical training initiates cardiopulmonary resuscitation (CPR). Traditionally, that CPR has included both rescue breathing (to keep the lungs ventilated and supplied with oxygen) and chest compressions (to maintain blood flow to the vital organs). However, in recent years, studies have suggested that it’s best to forego the rescue breathing and only do chest compressions.

This conclusion has come as a relief to potential CPR performers, both because rescue breathing can be tricky and because it obviates the need to attach one’s mouth to that of a stranger of unknown medical condition. Unfortunately, according to Aaron Orkin of the University of Toronto, it now looks like that verdict may have been premature. Rescue breathing may not be necessary in urban settings where the victim is likely to receive real medical attention fairly quickly, but it can be a lifesaver in situations where response teams are delayed.

Orkin conducted a literature search to find out how rescue breathing altered survival rates for adult cardiac arrest victims in various settings. The studies were conducted all over the world. He found that while rescue breathing did not improve outcomes in cases where the patient received professional medical care in under five minutes, some studies did show that CPR with rescue breathing was slightly better for patients who had to wait over fifteen minutes for medical attention.

So, what’s a well-meaning bystander to do? 

First, I’m not a medical professional, so you should take my opinions for the inept conjectures they are. Got that?

Second, the sad truth is that very few people come back from being resuscitated unscathed. Fewer than a quarter of patients survive the event even when it happens in the hospital right in front of doctors. For people who have a cardiac arrest outside of a hospital, that figure is less than 10%. And that’s counting everyone who is successfully resuscitated. The percentage of people who subsequently leave the hospital neurologically intact is much lower. This means that despite anyone’s best efforts, it may not matter whether a CPR-performing bystander included rescue breathing. 

One huge caveat: not everyone who stops breathing does so due to heart failure. This is particularly true of children, who are also more likely to benefit from rescue breathing. Plus, you never know if the victim in front of you would have been the one to beat the odds. 

Bottom line, bystanders should definitely perform CPR if they can. Whether or not to include rescue breathing may depend mainly on how competent and/or willing they are.

Orkin, A. (2013). Push hard, push fast, if you're downtown: A citation review of urban-centrism in American and European basic life support guidelines Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 21 (1) DOI: 10.1186/1757-7241-21-32.

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