Key element of CPR missing from guidelines

by Anne Craig
Anthony Ho says CPR guidelines are missing a key component.

Removing the head tilt/chin lift component of rescue breaths from the latest cardiopulmonary resuscitation (CPR) guidelines could be a mistake, according to Queen's University professor Anthony Ho.

Traditional CPR guidelines for out-of-hospital cardiac arrest by lay include rescue breaths. These are delivered using a combination of head tilt/chin lift and mouth-to-mouth breathing. Under the new guidelines, these are now omitted.

"Wholesale elimination of ventilation from CPR by laypersons for adults with out-of-hospital may be misguided," says Dr. Ho (Anesthesiology and Perioperative Medicine), who is also at Kingston General Hospital.

"It is important to remember that rescue breathing is a two-part intervention: head-tilt-chin-lift and delivery of rescue breaths. Head-tilt-chin-lift, the key to overcoming obstruction in the upper airway in unconscious patients, is not the reason for all the undesirable effects of rescue mouth-to-mouth breathing."

The new guidelines, issued by the International Liaison Committee on Resuscitation in 2010, recommend CPR using only chest compressions if performed by untrained bystanders. Mouth-to-mouth resuscitation was removed from the guidelines as it can delay or interrupt chest compressions, too much ventilation could be provided, and bystanders   may be reluctant to perform it.

With a survival rate of only 14 per cent for compression-only CPR, Dr. Ho says there is a lot of room for improvement. Dr. Ho's commentary was published in the most recent edition of the Canadian Medical Association Journal.

More information: Anthony M.-H. Ho, Song Wan, and David C. Chung. "Adding the head-tilt-chin-lift technique to adult compression-only CPR by untrained bystanders." CMAJ cmaj.131847; published ahead of print July 28, 2014, DOI: 10.1503/cmaj.131847

Related Stories

New studies confirm chest compressions alone

date Dec 26, 2007

Two large-scale studies published in the Dec. 18 issue of the American Heart Association’s medical journal, Circulation, report that the chances of surviving cardiac arrest are no better – and may be worse – when b ...

Dispatcher-assisted CPR increases survival among children

date Apr 30, 2014

Children who suffer cardiac arrest outside the hospital are more likely to survive and have good brain function if dispatchers instruct bystanders on CPR, according to a large Japanese study published in Journal of the Am ...

Recommended for you

Cardinal Health paying $26.8 million in FTC settlement

date Apr 20, 2015

Cardinal Health will pay $26.8 million as part of a settlement with the Federal Trade Commission over charges it monopolized the sale in 25 markets of diagnostic drugs known as low-energy radiopharmaceuticals.

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.