How Good Are Your Rescue Breathing Skills?

When you take a CPR class you learn a variety of different resuscitation skills including chest compressions and rescue breathing (mouth-to-mouth or mouth-to-mask). Although some instructors may not emphasize rescue breathing and airway skills, these are important lifesaving tools.

The American Heart Association (AHA) and other groups recently changed their CPR recommendations and now advise untrained bystanders to use compressions-only CPR (“hands-only CPR”). This was done to make CPR simpler and encourage more people to do CPR.

Some studies have shown compressions-only CPR to be as effective as conventional CPR in certain situations.(1) One recent study even suggests it’s more effective.(2) If compressions-only CPR works then why not forget about rescue breathing altogether? As a trained rescuer there are several reasons why you should know rescue breathing and airway skills.

Non-Cardiac Causes of Cardiac Arrest
The heart can stop beating for two main reasons: when there’s not enough oxygen (such as drowning or suffocation) and when there’s a problem with the heart’s electrical system (such as sudden cardiac arrest).

About 25% of cardiac arrests primarily are due to a lack of oxygen.(3) For example, in cases of drowning, respiratory arrest quickly leads to cardiac arrest. Drug overdose can cause respiratory depression and respiratory arrest that leads to cardiac arrest. In these cases, rescue breathing would be an important part of the resuscitation effort because the victim likely has no or little oxygen in his or her body. Chest compressions alone won't help because there is no oxygen in the blood. Oxygen is what the brain and heart need.

In addition, someone with a complete airway obstruction needs the object removed. This requires airways skills such as the Heimlich maneuver and/or abdominal thrusts which are taught in many CPR courses.

Cardiac Arrest In Children
Cardiac arrest in children typically is caused by a condition that prevents breathing, for example, choking or suffocation. Studies have shown chest compressions and ventilations are the most effective treatment for children and infants in cardiac arrest.

If a child is found unresponsive, the underlying cause typically is respiratory and not heart-related. In this case the child needs rescue breathing. Rescue breathing is important for children and infants in cardiac arrest. Compressions-only CPR is only for teens or adults whom you see suddenly collapse.

The American Heart Association recommends CPR with a combination of breaths and compressions for:

•All infants (up to age 1)
•Children (up to puberty)
•Anyone found already unconscious and not breathing normally
•Any victims of drowning, drug overdose, collapse due to breathing problems, or prolonged cardiac arrest (4)

Conclusion
For the majority of cardiac arrest victims, chest compressions and early defibrillation are vital. But breathing and airway skills have their place, too. As a trained rescuer you should provide rescue breaths to adult victims if you able.

Rescue breaths are important especially when a victim’s breathing stopped before the heart stopped and there is a lack of oxygen in the body. This includes victims of suffocation and other situations where a lack of oxygen caused the heart to stop. The AHA recommends them in unwitnessed cardiac arrest.

Finally, always provide rescue breaths with chest compressions when doing CPR on children and infants.

References

1. Bobrow BJ, Spaite DW, Berg RA, et al. Chest Compression–Only CPR by Lay Rescuers and Survival From Out-of-Hospital Cardiac Arrest. JAMA. 2010;304(13):1447-1454.

2. Iwami T, Kitamura T, Kawamura T, Mitamura H, Nagao K, Takayama M, Seino Y, Tanaka H, Nonogi H, Yonemoto N, Kimura T; for the Japanese Circulation Society Resuscitation Science Study (JCS-ReSS) Group. Chest Compression-Only Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest With Public-Access Defibrillation: A Nationwide Cohort Study. Circulation. 2012 Dec 11;126(24):2844-2851.

3. McNally B, Robb R, Mehta M, Vellano K, Valderrama AL,Yoon PW, Sasson C, Crouch A, Bray Perez AB, Merritt R, Arthur Kellermann A. Out-of-Hospital Cardiac Arrest Surveillance -- Cardiac Arrest Registry to Enhance Survival (CARES), United States, October 1, 2005--December 31, 2010. Morbidity and Mortality Weekly Report. 2010:60(8). Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6008a1.htm. Accessed 12/10/12.

4. Hands Only CPR: Learn More [Internet]. Dallas, Tx: American Heart Association; c2013. Available from: http://www.heart.org/HEARTORG/CPRAndECC/HandsOnlyCPR/LearnMore/Learn-More_UCM_440810_FAQ.jsp. Accessed 12/18/12.