I N T R O D U C T I O N
Current CPR guidelines combine closed-chest cardiac compression
with assisted ventilation, either by rescue breathing
or by bag-valve-mask. Assisted ventilation supports
pulmonary gas exchange, whereas closed-chest compression
generates sufficient ventricular pressure to move ventilated
blood through the circulatory system. CPR is recommended
to maintain a minimal flow of oxygenated blood
to the heart and brain in the interval between ventricular
fibrillation and successful defibrillation.1
Some clinical and experimental studies have questioned
the need for assisted ventilation during resuscitation after
cardiac arrest. A study by Van Hoeyweghen et al2 evaluated
the outcomes in 3,306 out-of-hospital cardiac arrests and
found that a significant number of European health care
workers already omit mouth-to-mouth rescue breathing
during CPR. In out-of-hospital primary cardiac arrests, chest
compression alone was used in 263 cases and combined
chest compression and rescue breathing in 443. The 16%
survival rate for the group receiving rescue breathing was
greater, but not significantly so, than the 10% survival rate
for the group receiving chest compression alone. The lack
of statistical significance may reflect the relatively small sample
size and the wide range of times between cardiac arrest
and attempted resuscitation. The lack of a clear advantage
to rescue breathing focused attention on the role of rescue
breathing as an essential component of CPR.
I N T R O D U C T I O NCurrent CPR guidelines combine closed-chest cardiac compressionwith assisted ventilation, either by rescue breathingor by bag-valve-mask. Assisted ventilation supportspulmonary gas exchange, whereas closed-chest compressiongenerates sufficient ventricular pressure to move ventilatedblood through the circulatory system. CPR is recommendedto maintain a minimal flow of oxygenated bloodto the heart and brain in the interval between ventricularfibrillation and successful defibrillation.1Some clinical and experimental studies have questionedthe need for assisted ventilation during resuscitation aftercardiac arrest. A study by Van Hoeyweghen et al2 evaluatedthe outcomes in 3,306 out-of-hospital cardiac arrests andfound that a significant number of European health careworkers already omit mouth-to-mouth rescue breathingduring CPR. In out-of-hospital primary cardiac arrests, chestcompression alone was used in 263 cases and combinedchest compression and rescue breathing in 443. The 16%survival rate for the group receiving rescue breathing wasgreater, but not significantly so, than the 10% survival ratefor the group receiving chest compression alone. The lackof statistical significance may reflect the relatively small samplesize and the wide range of times between cardiac arrestand attempted resuscitation. The lack of a clear advantageto rescue breathing focused attention on the role of rescuebreathing as an essential component of CPR.
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