Basic Life Support with no kissing scene? Where's the fun?!?

When we watch some action movies, we tend to see CPR a.k.a cardiac pulmonary resuscitation with the component of chest compressions and the heroic kissing scenes. Well....not exactly kissing, blowing air to be frank, giving the artificial breathing.

Mouth-to-mouth artificial breathing has been a component of Basic Life Support (BLS) sequence for ages. Though some people might grossed out to do so for a very reasonable reason: exchanging bodily fluids with unknown person which might lead to transmission of infectious disease. Well, since it is a guideline, the BLS providers are encouraged to do so. But, how about the evidence, does giving mouth-to-mouth artificial breathing give more benefit?

Removing mouth-to-mouth artificial breathing is rather a new concept which come from several reasons regarding the downside of giving artificial breathing, which are:

1. Transmissible disease between the patient and the provider
2. An unnecessary distraction (especially for the untrained BLS provider) for the most vital component of CPR: chest compression 

Moreover, the part of giving the patient artificial breathing may be replaced by the automatous breathing effect from the chest compression. Giving a chest compression might give secondary effect of pushing the air out and pulling it in, which supposedly give quite sufficient oxygen to the patient (compared to the breathe-out air from the patient which also contains more CO2).

Those are mainly the talk about the theory and stuffs, but how's the survival rate reported in the study? This is an interesting paper where the evidence come to play: Compression-Only CPR or Standard CPR in Out-of-Hospital Cardiac Arrest, comparing the survival rate in 1-day and 30-days between the use of compression-only CPR and the standard CPR. 

"The result showed a 30-day survival rate of 8.7% in the group receiving compression-only CPR and 7.0% in the group receiving standard CPR, while 24.0% of the patients receiving compression-only CPR survived for 1 day, as did 20.9% of those receiving standard CPR. There were no significant differences between the two groups with respect to the other secondary end points."

Well, we might see a little difference in survival rate, quite visible in compression-only CPR result for both 1-day and 30-days survival rate, though it was considered as no significant differences. Meaning? mouth-to-mouth artificial breathing supposedly will not give better result, considering the "extra miles" we have to go through doing it, than compression-only CPR.

As for now, compression-only CPR hasn't been approved as a guideline, though I have a standpoint of  doing so when doing BLS for outpatient setting.

Kudos to dr. Rahul Goswami for introducing me to this topic. His blog, emergence phenomena, can be accessed here: singem.blogspot.com