Compression-Only CPR vs. CPR with Rescue Breaths

Cardiopulmonary resuscitation (CPR) is a critical life-saving technique used to restore blood circulation and oxygen supply to a person experiencing cardiac arrest. Compression-only CPR, also known as hands-only CPR, has gained attention as an alternative to traditional CPR, which combines chest compressions with rescue breaths. While compression-only CPR offers some advantages and can be effective, it’s essential to understand its pros and cons, as well as situations where it might not be appropriate.

Pros of Compression-Only CPR

Simplicity and Accessibility: One of the most significant advantages of compression-only CPR is its simplicity. This technique involves only chest compressions, eliminating the need for mouth-to-mouth breaths. This simplicity makes it more accessible to bystanders who might hesitate to perform mouth-to-mouth rescue breaths due to concerns about hygiene or fear of doing it incorrectly.

Higher Likelihood of Bystander Assistance: Studies have shown that people are more willing to initiate compression-only CPR than traditional CPR, primarily due to the elimination of the rescue breath component. This means that bystanders are more likely to step in and provide aid in the critical moments following cardiac arrest, potentially increasing the victim’s chances of survival.

Minimized Interruptions: Continuous chest compressions maintain blood flow to vital organs, reducing the interruptions that occur when switching between compressions and rescue breaths. This uninterrupted circulation of blood and oxygen can increase the likelihood of a successful resuscitation.

Easier Training: Teaching compression-only CPR is simpler and less time-consuming compared to traditional CPR. This means that more people can be trained in basic life-saving techniques, spreading awareness and preparedness within the community.

Can be effective: Studies have shown that if someone has a sudden cardiac arrest, oxygen levels in the body remain sufficient for the first few minutes. This means that compressions done right away are effective at moving that oxygen to vital organs of the body, such as the brain and heart.

Cons of Compression-Only CPR

Limited Oxygen Exchange: One of the primary drawbacks of compression-only CPR is the lack of oxygen exchange. While chest compressions can maintain blood circulation, they provide limited oxygen to the body. In cases where the victim has experienced a respiratory arrest rather than a cardiac arrest, the absence of rescue breaths could actually worsen their condition.

Less Effective for Certain Cases: Compression-only CPR is far less effective when the cardiac arrest is due to factors other than a primary cardiac event. For example, in cases of drowning, drug overdose, or situations involving children or infants, who are more likely to have cardiac arrest from respiratory causes, a combination of chest compressions and rescue breaths will be much more appropriate. In these cases, compressions and rescue breaths are recommended if the bystander is trained and is willing to do so.

Potential for Fatigue: Performing high-quality chest compressions requires a certain level of physical strength and stamina. Bystanders might become fatigued over time, leading to a decrease in the effectiveness of compressions. In contrast, traditional CPR allows for alternating between compressions and rescue breaths, potentially reducing the risk of fatigue.


When Compression-Only CPR is Not Appropriate

Drowning Incidents: Drowning often leads to oxygen deprivation rather than a primary cardiac event. In such cases, rescue breaths are crucial for replenishing the body’s oxygen levels. Traditional CPR with a combination of chest compressions and rescue breaths is recommended for drowning victims.

Pediatric Cases: Children and infants might experience cardiac arrest due to various causes, including respiratory issues. These cases require immediate attention to restore both blood circulation and oxygen supply. For pediatric victims, traditional CPR that includes rescue breaths is recommended.

Drug Overdose and Poisoning: Similar to drowning cases, instances of drug overdose or poisoning can lead to compromised breathing and oxygen deprivation. Providing rescue breaths alongside chest compressions can significantly improve the victim’s chances of survival. In fact, many organizations recommend rescue-breaths only for people who are overdosing on Opioids. Of course, for these people you should also administer Naloxone if it is available. This is because they will slip into respiratory arrest first, while their heart is still beating, and rescue breaths will keep them alive. Also, rescue breaths can be done by bystanders who are not trained in CPR.

In conclusion, compression-only CPR offers a simplified and accessible approach to bystander-assisted resuscitation. Its benefits include ease of training, increased bystander willingness to help, and reduced interruptions during chest compressions. However, it’s crucial to recognize its limitations, such as the lack of oxygen exchange and reduced effectiveness in certain cases. Compression-only CPR is taught in many Vancouver first aid courses, however understanding when to apply compression-only CPR and when to opt for traditional CPR with rescue breaths can significantly improve the chances of a successful resuscitation and contribute to better overall outcomes in cardiac arrest situations. The bottom line is everyone should receive training in CPR with Rescue breaths, and have access to AED’s and Pocket masks. In this perfect world we would all choose the traditional 30:2 compression to breath ratio when performing CPR.

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