Health: Hold Your Breath

New CPR recommendations take mouth-to-mouth out of the mix

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New CPR recommendations take mouth-to-mouth out of the mix

In the summer of 2008, Carol Putnam was at home with her husband, Kirk, when he collapsed from sudden cardiac arrest at their Gig Harbor residence. Putnam, who had received training in conventional CPR when she was in the Army, saved her husband’s life by giving him only chest compressions—despite her training to also do mouth-to-mouth breathing.

The 46-year-old soccer enthusiast (who also called 911) credits her years of playing the sport with giving her the endurance to continue CPR for nearly 10 minutes until help arrived. “I was envisioning pumping his blood throughout his body,” she says, “at the same time I was yelling at him not to die.”

Her choice to do compression-only CPR was a deliberate one, the result of having seen a TV report claiming this technique was as effective as using it in conjunction with mouth-to-mouth breathing. In 2008, the American Heart Association (AHA) began endorsing a revised hands-only technique; in other words, today’s recommended CPR involves only chest compressions and eliminates mouth-to-mouth resuscitation. Surprisingly—especially in Seattle, which is known as a national leader in CPR training—many people seem unaware of the change, acknowledges Dr. Jonathan Drezner, an associate professor in the department of family medicine at the University of Washington and an expert in sudden cardiac arrest. He notes that there is an expected lag time between the AHA’s endorsement of the new technique and when it is reflected in seminars and in educational materials, and when word reaches the general public.

The AHA says about 310,000 adults die every year in the United States from sudden cardiac arrest that occurs outside a hospital setting. Without immediate CPR, a victim’s chance of survival decreases 7 percent to 10 percent per minute. Though Seattle has more bystander participation than any other city in the country, the new guidelines are intended to encourage even more intervention.

The change in guidelines also makes CPR simpler, says Francesca Fabile Minas, AHA communications director for Washington. “Calling 911 right away and starting compressions helps improve survival, and the best thing about hands-only CPR is that anyone can perform this lifesaving technique.” Dr. Mickey Eisenberg, professor of medicine at the University of Washington and medical director of King County Emergency Medical Services, favors the revised technique, saying hands-only CPR will eventually lead to more lives being saved. And his colleague Drezner adds: “When someone collapses, they have enough oxygen for several minutes. So if you do chest compressions, you’re still going to circulate some amount of oxygenated blood.”

Hands-only CPR, however, has not rendered conventional CPR obsolete. The AHA says the new approach is for laypeople who see an adult suddenly collapse and are not trained in conventional CPR; those leery of performing mouth-to-mouth breathing for fear of contacting an infectious disease; and bystanders who lack confidence giving both chest compressions and mouth-to-mouth breathing. The AHA still recommends conventional CPR with mouth-to-mouth for all infants and children; adult victims who are already unconscious and not breathing normally; for victims of drug overdose or drowning; and for those who collapse due to breathing trouble.

Meanwhile, it’s comforting to know that Seattle remains ahead of the curve. Eisenberg says the Emerald City ranks number one in CPR preparedness. “Seattle has a 50 percent to 60 percent bystander CPR rate, which is astounding; no other community nationally or internationally comes close.” Let’s hope the hands-only technique boosts that percentage eve