New advice on giving CPR

A person suffering a heart attack whose heart has stopped beating and who receives cardiopulmonary resuscitation (CPR) fares better if resuscitators skip the rescue breaths and do only chest compression, according to a study  at Washington University School of Medicine in St. Louis.

"When we combined three studies, there was a significant increase in survival when witnesses were told by 911 dispatchers to provide chest compression only," said principal investigator Peter Nagele, MD.

The three studies covered survival rates in more than 3,700 cardiac arrest patients who received either standard CPR or chest compression only.

"When a person goes into cardiac arrest because of a problem with the heart, that individual normally has plenty of oxygen in the body," said Nagele,assistant professor of anesthesiology and chief of trauma anesthesiology at Barnes-Jewish Hospital in St. Louis. "So rescue breaths aren't as vital to survival as trying to keep blood flowing as regularly as possible. However, if cardiac arrest is secondary to trauma, drowning or a problem not directly related to heart function, then it is advisable to do standard CPR that includes rescue breaths. In those cases, getting oxygen into the system is crucial."

But it's different with children.

"It is very uncommon for kids to go into cardiac arrest due to a primary heart problem," Nagele says. "If cardiac arrest does occur, it's likely to be secondary to a severe asthma attack, an allergic reaction or something else unrelated to the heart. Under those circumstances, the body needs oxygen. I strongly recommend chest compression and rescue breaths in kids."

The study found that the benefit occurred only when 911 dispatchers coached bystanders to use chest compression-only CPR. In several uncontrolled studies that simply asked bystanders whether they did only chest compressions or standard CPR, the investigators found no survival benefit with the chest compression-only technique.

Nagele says his findings suggest that if someone nearby has a heart attack, it's important to first call 911, and then begin chest compressions. He says if it takes several minutes for help to arrive, it also may become necessary to begin rescue breaths, but for the first five to 10 minutes, chest compressions are more important.