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Hands-Only CPR Gains Support

If the thought of putting your lips on a stranger's mouth to administer CPR is a little more than daunting, you're not alone.

Recent reports indicate that while many of us know how to do CPR, actually doing it to someone is another matter. The idea of mouth-to-mouth breathing is enough to make some bystanders not want to get involved.

"I think in the present day and age when people are concerned about infectious diseases that it's very reasonable to be reluctant to do CPR, to do mouth to mouth on a person," said cardiologist Dr. Kenneth Deloge of Concord Hospital. "But what's clear now is we're probably better off just compressing that person and not even worrying about the mouth to mouth until the ambulance gets there ... to restore breathing at that time, and they would use a bag pressure mask to do that."

A new form of CPR is being championed by doctors across the country. It's called cardio cerebral resuscitation, or CCR, which includes rapid, forceful chest compressions, about 100 per minute, without mouth-to-mouth breathing.

"Traditional cardiopulmonary resuscitation has stressed both the circulatory component of chest compressions plus the breathing," said Dr. Deloge. "What's becoming more apparent is that the chest compressions are much more important, and it's actually the blood flow to the brain is much more important than the oxygen level, per se. In fact, there are a lot of studies that are being done, and now the American Heart Association hopefully will start promoting hands-only CPR for bystanders, for lay people so that the old cardio-pulmonary resuscitation of doing a couple of breaths and then starting compressions and then doing the 30 to 2 probably will go by the wayside. People just need chest compressions until ACLS is there, until ambulances are there, and they'll do just as well, if not better, neurologically with that."

The American Heart Association now recommends compression-only CPR for anyone who is unwilling or unable to provide mouth to mouth.

"It takes actually about 30 compressions to build up the pressure that you're circulating through the person again," said Dr. Deloge. "Chest compressions are much more important than we used to think. One of the exciting things we're doing is we're going to try a device called the LUCAS device that's actually a little machine that will do the chest compressions for us at a hundred a minute and we can continue to do whatever we want in that time.

"We'll start it in an ER situation, but it would be great to get it in ambulances in the community. With a device like this, paramedics can literally be bringing a patient down stairs with CPR still going on. It frees them up to do what they need to do," he said.

Dr. Deloge said that if someone collapses and they're getting chest compressions, "that's great, and if hands-only CPR is going to facilitate that, that's great as well because they're better off getting that than having someone saying, 'I'm not going to do anything because I'm not going to do the mouth-to-mouth portion of it.'"

He cited two studies recently released in the New England Journal of medicine that showed a trend of patients doing better with hands-only CPR. The study done in the Midwest indicated that with professional services, rescue personnel didn't try to breathe into the person until they had done 600 compressions.

"That's six minutes without breathing and people actually did better than with breathing," Deloge said. "So the future will be hands-only hopefully with good results."


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