Rescue breaths have recently become a hot topic in the media and amongst the emergency care training industry yet again. When the 2010 CPR and ECC guidelines were released, we were bombarded with the message that rescue breaths had been eliminated from CPR. But that wasn’t the whole picture. A real explanation of the benefits of rescue breaths was needed, but unfortunately, the headlines left a lot to be desired. Now that rescue breaths have come into question again, we’d like to take this opportunity to clear up some confusion.
The Need for Rescue Breaths Depends on the Emergency
Cardiac arrest occurs for two primary reasons: sudden cardiac arrest (SCA) and secondary cardiac arrest.
SCA happens abruptly when the electrical system of the heart causes the heart to stop pumping. Forward blood and oxygen flow ceases, and normal breathing stops. However, uncirculated oxygen remains in the bloodstream. Research shows that chest compressions without rescue breaths can effectively circulate the remaining oxygen for the first few minutes. Between this research and other influencing factors - like the potential risk of the victim vomiting and additional details of learning how to properly give rescue breaths (ex: opening the airway and creating an airtight seal) - eliminating rescue breaths appears to be a reasonable concept.
However, secondary cardiac arrest requires providing effective rescue breaths. Secondary cardiac arrest happens when an initial airway or breathing problem prevents oxygen from entering the body. This is the most common way cardiac arrest occurs in children. Secondary cardiac arrest can be caused by medical emergencies like drowning, suffocation or opioid overdose. The lack of available oxygen will progressively weaken until the heart stops. Getting oxygen into the body becomes critical as it will stimulate the heart to beat faster and become stronger. It will also trigger the resulting oxygen to reach the brain and stimulate the breathing effort.
Although eliminating rescue breaths for CPR would make providing care more straight forward for a victim of SCA, it would not help a victim of secondary cardiac arrest. Because the cause of medical emergencies cannot always be definitively determined by a lay provider, it’s crucial we teach traditional CPR with compression-only CPR as an alternative option for providing care.
Rescue Breaths are Critical for Trained CPR Providers
For certified lay providers, rescue breaths are still a critical component of performing CPR. As Instructors, traditional CPR should always be taught with rescue breaths in order to increase the chance of survival.
For the untrained lay provider, the option to perform compression-only CPR helps to eliminate hesitation or unwillingness to provide care. This was one of the underlying goals of the CPR guidelines update: eliminate barriers to action. Learning compression-only CPR requires only a few minutes of time and can be easily communicated to the masses, resulting in more people taking action. Compressions without breaths is always better than doing nothing at all.
EMS Safety Instructors play a vital role in communicating the differences in traditional CPR and compression-only CPR, including explaining the limitations of compression-only CPR and providing situations where compression-only CPR is not recommended. We should provide awareness training in compression-only CPR, but always encourage our workplaces and communities to get certified in traditional CPR to increase outcomes.