Mouth to Mouth Resuscitation: Going Past the Fear

According to the American Heart Association, Cardiopulmonary Resuscitation (CPR) begins with chest compressions FIRST followed by breaths at a ratio of 30 compressions to 2 breaths. For many of us who remember, prior to the change in 2010, CPR used to begin with 2 breaths first followed by compressions. At that time, we were following the ABC’s of CPR, which was Airway, Breathing, and Circulation. Today, it switched with Circulation being first, then Airway and lastly, Breathing.

The clinical concept behind this change is purely anatomic. When a person goes into cardiac arrest, that person still has oxygen rich blood that is currently stagnant in the blood vessels. Because of this, chest compressions are more important than breaths.

By manually compressing the heart, you would be able to transport much needed oxygen to important organs in the body- mainly, the brain, heart, lungs, kidneys, liver.

This is also why Compressions Only CPR is acceptable in many circles. Some studies in fact show that Compressions Only CPR is just as effective as High Quality CPR, which includes compressions, breaths and the use of an Automated External Defibrillator (AED). Although the American Heart Association emphasizes High Quality CPR due to the increased chance of survival for victims.

Another reason, I believe, that this is helpful is to encourage those who were trained in CPR to use their skills in saving a life. Many people have the fear of mouth-to-mouth resuscitation. The thought of giving a no-holds bar “kiss” on someone you may not know can be very traumatic to others and a point that wastes precious time during these critical moments. I have heard on some occasions where students would jokingly say they wouldn’t give rescue breaths on Joe or Jill. Who knows where that mouth has been.


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The truth of the matter is that CPR is not a clean procedure. It is a dirty and nasty act that may require you to take a shower after. You will be on the ground with someone and it may be while you are wearing your Sunday best.

Imagine this, you are a member of a Waste Management team (Garbage men) who are returning from picking up the overflowing waste bins of the city’s animal shelters. You are all tired, sweaty and you can’t wait to wash your hands. Suddenly, one of your team mates clutches his chest, gurgles and spits out a black/green tobacco liquid that bathes his teeth (yes, he chews). He looks at you and reaches out for help, vomits out his breakfast and slaps facedown right in the middle of it. You are all horrified to see this happen despite joking about how out-of-shape your team mate was yesterday. You are even more horrified to remember that you all just learned how to do CPR a few days ago.

You all automatically do the first steps:
– checking for scene safety
– checking for responsiveness
– activating the emergency response system (one of your fastest teammates was thankful to have done this first)
– checking for breathing

You turn him over and he is not responsive as his spit and pieces of vomit slides down the side of his mouth and nose. You determine he isn’t breathing and, if this happened prior to 2010, the next step is to give your teammate rescue breaths. At that point you look at each other… what next? I’m not saying this ever happened as I do not know every emergency cases that occurred in the past. But, there is a strong case, in terms of human nature, to say that CPR may have ended with checking for breathing.

In this scenario, the change to compression first before breaths or the use of compressions only CPR was a great move. Many would be more willing to provide CPR if they could avoid contact with another person’s bodily fluids or decrease the risk for infection. The AHA further encourages many First Aid kits and AEDs to include a face shield or mask with a one- way valves. Because of this, if your First Aid Kit does not include a face shield or mask with a one- way valve, invest in purchasing them online. If possible, get one for an adult, child and infant, especially if you work in a daycare or school.

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