Cardiopulmonary Resuscitation (CPR) is a life-saving technique performed when someone’s breathing or heart stops, restoring blood circulation and oxygenation to the brain and other organs. A common question arises regarding the necessity of rescue breaths within this procedure.
The Evolution of CPR Guidelines
CPR guidelines have undergone significant changes over time, particularly concerning the sequence of actions. Historically, the “ABC” approach—Airway, Breathing, Compressions—was emphasized. The American Heart Association (AHA) revised its guidelines in 2010, shifting to the “CAB” sequence—Compressions, Airway, Breathing—for lay rescuers.
This change occurred because delaying chest compressions to manage the airway and deliver breaths often reduced survival chances, especially in sudden cardiac arrest. Prioritizing immediate chest compressions ensures blood flow to the brain and other organs. The complexity of mouth-to-mouth resuscitation and discomfort with direct contact sometimes caused hesitation among bystanders, leading to delays or no intervention at all. The CAB method simplifies CPR, encouraging more immediate bystander action by focusing on compressions first.
When Rescue Breaths Remain Crucial
Despite the shift towards compressions, rescue breaths are still life-saving in specific scenarios. Situations where the cause of collapse is likely respiratory, rather than a sudden cardiac event, require oxygen delivery as an immediate priority. These include incidents such as drowning, opioid overdose, choking, and most cases of pediatric (infants and children) cardiac arrest.
In drowning, the body is deprived of oxygen from the start, making rescue breaths essential to re-oxygenate the blood. Similarly, opioid overdoses cause breathing to slow or stop gradually, meaning the victim’s blood is likely to have very low oxygen levels when they collapse. Providing breaths in these cases helps prevent the heart from stopping and brain damage from occurring. For infants and children, respiratory issues are more frequently the cause of cardiac arrest, making the combination of compressions and breaths more effective.
Hands-Only CPR for Adults
Hands-Only CPR is a simplified form of cardiopulmonary resuscitation, focusing solely on continuous, high-quality chest compressions. This technique is recommended for sudden cardiac arrest in adults, particularly when witnessed, and is for untrained individuals or those hesitant to perform mouth-to-mouth. The rationale is that adults experiencing sudden cardiac arrest often have enough oxygen in their blood and lungs for the first few minutes, and continuous compressions effectively circulate this remaining oxygen.
To perform Hands-Only CPR, the rescuer should push hard and fast in the center of the chest, on the lower half of the sternum between the nipples. Compressions should be at least 2 inches deep, but no more than 2.4 inches, delivered at a rate of 100 to 120 compressions per minute. Allow the chest to fully recoil after each compression to ensure adequate blood flow return to the heart. Continue these compressions without interruption until emergency medical services arrive or the person shows signs of movement.