Does Active Rescuer Ventilation Have a Place During Basic Cardiopulmonary Resuscitation?

Abstract

Rescuer ventilation has always been an integral part of both basic (BLS) and advanced (ACLS) cardiac life support.1 Despite 5 decades of continuous attempts to improve training in cardiopulmonary resuscitation (CPR), maintenance of free airways and adequate ventilation continue to be difficult skills to acquire and maintain for both lay persons and professionals. Because of airway problems and excessive inflation pressures, much of the air enters the stomach instead of the lungs during bystander CPR,2 and in a recent study, 39% of patients receiving mouth-to-mouth ventilation had signs of regurgitation at the time of intubation.3 Article p 2525 Bystander CPR increases overall survival in the great majority of clinical studies, but as suspected, the quality of the bystander effort is important. Poor-quality CPR did not increase survival compared with no CPR in 3 clinical studies.4–6 In addition, although the frequency of bystander BLS is as high as 50% to 60% in areas with a long-standing tradition in lay-person CPR training and performance,7,8 others report much lower and falling frequencies.9 This is at least partly due to rescuers’ reluctance to perform mouth-to-mouth ventilation because of fear of disease transmission or esthetic reasons.10,11 Adding the difficulty of instructing ventilations over the telephone, Hallstrom et al7 conducted a randomized study of emergency dispatch telephone instruction in BLS with or without mouth-to-mouth ventilation with 14.6% survival for compressions only versus 10.4% for standard BLS ( P =0.18). In parallel, the CPR research group at the University of Arizona has over the last 15 years conducted a series of studies on the efficacy of chest compressions only versus standard CPR in pigs.9,12–17 The group consistently report better hemodynamics and equal or better outcome with chest compressions only than with standard BLS with 15:2 compression-to-ventilation ratio. …