July 28, 2010— -- Imagine for a moment, you and your friend are having dinner in a small restaurant and suddenly your friend stops breathing and collapses on the floor. You yell out for someone to call '911.' But then what?
Precious seconds, even minutes might be wasted while you're waiting for emergency medical services (EMS) to arrive. And for many it may mean the difference between life and death.
According to the American Heart Association, providing cardiopulmonary resuscitation (CPR) – a combination of mouth-to-mouth breathing and chest compressions -- immediately after sudden cardiac arrest can double or triple a victim's chance of survival. However, less than one-third of those who suffer sudden cardiac arrest outside of a hospital receive CPR from a bystander.
"I think there's some fear of getting it wrong," said Dr. Richard Page, former president of the Heart Rhythm Society, and current chair of the Department of Medicine, University of Wisconsin.
Two new studies published Wednesday in the New England Journal of Medicine suggest that if you're not sure how to properly administer CPR, chest compressions alone may be as effective, if not more effective, than the traditional CPR which calls for both chest pumping and rescue breathing.
In both studies, bystanders followed instructions given over the phone by emergency medical dispatchers. In the first study, emergency dispatchers in Seattle and King County, WA. advised bystanders to give 981 patients chest compressions alone, and 960 were given chest compressions and rescue breathing. Researchers found approximately the same number of people in each group survived to reach the hospital.
The other study looked at 620 patients in Sweden who received just chest compressions and 656 patients who had standard CPR. The study found the same number of people in each group survived after one month.
Bystander CPR is designed to buy time until trained professionals arrive on the scene. Many experts said some inexperienced rescuers who try to perform mouth-to-mouth breathing may take valuable time away from urgently needed continuous chest compressions.
"If I'm laying here and we're waiting for the defibrillator to arrive, I don't need oxygen [right away], I need circulation of the air I have to my vital organs," said Page. "As you push hard and fast, you are moving air."
Many people inexperienced in CPR interrupt each set of chest compressions for an average of 16 seconds while they deliver the recommended "2 quick breaths," according to a 2007 article published in "Circulation."
According to Dr. Michael Sayre, associate professor of emergency medicine at Ohio State University, rescue breathing is not appropriate in all first aid situations and may waste time especially if done by someone inexperienced in traditional CPR.
"Providing instructions in mouth-to-mouth breathing over the telephone is difficult. It's hard to get somebody to really do it and actually deliver enough air to make a difference," said Sayre. "I think it can help in cases like drowning, and I would advocate providing instructions in those sorts of circumstances. But for most people, they really don't need air, they just need someone pushing on their chest and acting like an artificial heart for them."
According to Dr. Clifton Callaway, associate professor and vice-chair of emergency medicine at the University of Pittsburgh, CPR-trained bystanders and paramedics should not abandon the traditional CPR method. The suggestion for compressions alone should only stand until someone more experienced takes over.
"While a few minutes of chest compressions without ventilations can be tolerated and can support life, eventually the patient needs oxygen."
CPR is required when a victim is unresponsive and is not breathing. And although many movies feature actors always rushing to administer CPR -- sometimes to a complete stranger -- many experts say in reality, it's more likely that no one will come to your rescue.
CRP: Changing Guidelines, Saving Lives
Many studies suggest that bystanders are more willing to attempt resuscitation if mouth-to-mouth ventilations are not required.
"How many of us are willing to put our mouth on a total stranger," said Page. "I don't think there's significant risk on the operator, but there may be disincentive to do that and fear they'll do it wrong."
Sayre said many people may feel inexperienced and too afraid they may do something wrong.
"Part of the reason [many victims] don't get any form of CPR is because traditional CPR is fairly complicated," said Sayre.
According to Page, many people inexperienced with performing chest compressions might find the recommendation of 100 beats per minute -- or pumping the chest to the tune of Bee Gee's "Stayin' Alive" – to be intimidating.
Callaway said that bystander CPR is more likely to be performed for victims who collapse in a public setting where the chances of someone who is trained in first aid might respond.
"The greatest barrier to bystander CPR is that many cardiac arrests happen in the home or in private settings where bystanders may not be trained in what to do," said Callaway. "As a result, bystander CPR is often not performed.
There are dozens of public videos demonstrating chest compressions that anyone can access on the internet that can show people the right place to put the heel of their hand, Page said.
"You go ahead, you do your best," said Page. "The statistics are that most people who undergo cardiac arrest don't survive, so even if you do CPR, they may not survive, but you're certainly improving the chances they do survive." And, recommending one repetitive may get more people to engage in CPR, rather than watching those precious seconds and minutes pass, Sayre said.
"We really could save thousands of lives across the country if we could just get more people to do something simple like push hard and fast on the center of the victim's chest," said Sayre.
For a cheat sheet on chest compressions and CPR, visit http://handsonlycpr.org
Disclosure: Dr. Richard Page co-authored the American Heart association's statement on compression only CPR. Page also previously co-authored editorials advocating chest compressions.