Mouth-to-mouth resuscitation is sometimes responsible for the reluctance of would-be saviors to perform CPR on heart attack victims. Now, the state of Arizona is taking the problem in hand by promoting an alternative form of the lifesaving technique.
A few months ago, Scott Harden was just about asleep when he heard his 33-year-old wife gasping for air. "I turned on the lights," he recalls. "She was not the right color. She was starting to go pale."
Harden, a sheriff's deputy, called 911. Then he started giving CPR, the way he was first taught five years ago, with 15 compressions and two breaths.
"I started that, and I wasn't able to get a breath in. And I just thought, 'You better just do chest compressions,' " he says. "Dispatch had actually told me the same thing."
The phone dispatch counted out the compressions with him, 100 per minute. Pete Walka of Flagstaff's Guardian Medical Transport was one of the first paramedics on the scene.
"She's alive because he did really good compressions until we got there," Walka says.
Arizona health officials are convinced compression-only, or "hands-only," CPR gives them the best chance to save someone's life from cardiac arrest. The man behind that conviction is cardiologist Dr. Gordon Ewy of the University of Arizona.
Ewy says hands-only CPR is not only easier, but more effective. He stumbled on the importance of chest compressions when he listened to a recording of a woman trying to resuscitate her husband, he says.
"She came back to the phone and said, 'Why is it every time I press on his chest, he opens his eyes, and every time I stop to breathe for him, he goes back to sleep?' "
Ewy says a victim's blood is already oxygenated for several minutes after a cardiac arrest. What's most important, he says, is to keep both the heart — and the brain — alive by pumping that blood around the body. His research, based on animal models, shows rescue breathing can interfere with that. Just last year, the American Heart Association acknowledged Ewy's findings, but only in part. It updated its guidelines to say that compression-only CPR is appropriate for those not trained in the standard method. Ewy doesn't think that goes far enough.
"If you're trained or not, you want to do chest compression-only CPR," he says. "You want to get the blood going to the head, to the brain, and you don't want it to stop until somebody gets there to defibrillate the patient."
A recent study in the British medical journal The Lancet supports Ewy's position with the largest study on the issue to date. It tracked 4,000 victims of cardiac arrest in Japan. Those who received compression-only CPR had a survival rate nearly twice as high as those who received compressions plus mouth-to-mouth.
But Dr. Michael Sayre, who helped write the new guidelines for the American Heart Association, still isn't convinced compression-only CPR is better. Sayre teaches emergency medicine at Ohio State University. He says there just isn't enough evidence yet.
"Honestly, I think the research that we have to date shows that the outcomes for patients seems to be very similar regardless of the kind of CPR they get."
So Arizona has forged ahead on its own. The state began promoting chest compression-only CPR about five years ago. "We found that 3 out of 100 people who had a cardiac arrest outside the hospital in Arizona went home with their family." says Dr. Ben Bobrow, who directs Arizona's Bureau of Emergency Medical Services. The other 97 percent of victims died. "We had to do better," Bobrow says. "We felt we should be urgent about it; we shouldn't wait, for example, until the next set of guidelines got updated."
Bobrow helped convince most emergency responders across the state to adopt a new protocol — also developed by Ewy — called "cardio-cerebral resuscitation." CCR involves long sets of 200 chest compressions. And instead of forcing air into the lungs through a tube, paramedics give oxygen passively with a mask. Bobrow then compared the new results using compression-only with historic data.
"What we pretty much consistently found is that at least three times as many people survived neurologically intact and went home if they got this new form of resuscitation."
Bobrow's research has been published in the Journal of the American Medical Association and elsewhere. Still, the American Heart Association remains skeptical. It wants more conclusive evidence before it changes its guidelines any further.