Is mouth-to-mouth better than pocket mask CPR?

[Gary Thill]

(Reuters Health) - When lifeguards try to resuscitate a drowning victim, they typically perform rescue breaths through a mask placed over the victim's mouth. But a small study suggests that lifeguards may perform better with direct mouth-to-mouth breathing. Read the rest of the story here and sound off!

[Nick Bacon]

I would say absolutely not, unless you are without your pocket-mask!  Why would we take a step back in regards to the care we are providing?  While the ventilations may be more effective on a mannequin with mouth-to-mouth, what are the results on real victims? Also the benefits of using mouth-to-mask ventilations shouldn't be overlooked; most masks can be hooked to supplemental oxygen and/or directly to a BVM when one becomes available.  My opinion is that Lifeguards should continue to do what the rest of EMS is doing, and if there is improvement needed then we should train our LG's more effectively.

[Robert Burrows]

Two words: Universal Precautions. We train for this serious personal safety concern and comply with the law. Is their really any choice here? Good to know for the lay person though. RB

[Jim Wheeler]

I think the real problem from what I got out of the article is that people are less effective at making an airway with a pocket mask, I see so many youth in training that place the mask on then try to tilt the head back with fingers under the victims jaw pulling the mouth closed. Simliar to Nick's good point, the study was on dummies which also confuse people because they are nothing like real people. The same study also said it got even less air in to the lungs when they used a BVM... Finally, the researchers were more worried about constant compressions and the importance of keeping blood circulating and pointed out it was faster to ventilate with out the mask therefore more compressions could take place. 

 

[Jeanne-Marie Kavanagh]

I agree with all of you re: universal precautions.  Training and in particular practice with sealing the mask are absolutely essential. Recently I was assisting with a lifeguard training course and a student asked about hands only CPR - I think, Jim, that the high media profile of that technique for lay responders may be clouding the perspective of researchers in this study too.  The simple fact there is STANDARD OF CARE for lifeguards including using universal precautions and giving the most appropriate and highest level of care according to Professional Rescuer training.  It is a matter of professionalism; having appropriate equipment when on duty and being prepared to give care according to that standard. 

[Jeanne-Marie Kavanagh]

PS get a "like" button for comments : )

[Gerald M. Dworkin]

Absolutely, and no first responder should put themselves in a position to administer positive pressure ventilation without an adjunct device.

[Emma Schneider]

That story was ridiculous. I left a really long comment over on it, but yeah, i agree pretty much with everyone here.  I am both an EMT with the Fire Department, as well as a lifeguard.  Where Im from a lifeguard can get sent home if they dont have their own mask.  Most even carry the small barriers on their keys.  Also, werent we all taught that we had to keep ourselves safe first, then worry about others!!!

 

oh yeah and another thing BSI(body substance isolation)!!!!!!!!  If I ever saw a rescuer without gloves on or without using a pocket mask or barrier when caring for a patient, I would probably have an MI (heart attack)...

[bob pratt]

I don't think this is ridiculous at all. It should get us all thinking about our equipment and procedures.

Last year I worked a cardiac arrest of a 19 year old. Thankfully he survived. The arrest was complicated by difficulty in making a good seal with the standard issue pocket mask. The victim was very thin and his bone structure made getting a seal very difficult. I was was seriously considering switching to mouth to mouth. He ended up with bruising around his face and jaw.

We now also have softer "seal-easy" masks in our kits. We call them the "blob" mask and they work way better on those strange facial structures.

If the victim is a loved one; they will get mouth to mouth: it's more effective. There is a better seal, you can feel the breath go in and feel the resistance.

 

What do you beach guards do for submersion's? Wait til they are brought back to shore? With fins on I can give a couple mouth to mouth breaths holding onto a rescue can. I cannot give breaths in the water with a pocket mask (if I'm alone).

How would those adamant about universal precautions deal with a 10 year old with a down time of 8 minutes and a 4 minute return to shore time? I'm giving the kid a couple breaths and dealing with the consequences. It's easy to set absolutes in a classroom or a textbook but in the real world things get more complicated.

I'm not trying to pick a fight, just add some honesty,

 

bob

 

[Joe Batarse]

If by "better" you mean "efficacious," certainly mouth-to-mouth is mechanically superior. If by "better" you mean a standard of practice that reflects the mitigation of known risks, then undoubtedly a mask is superior. The ideal solution would posit the ease of direct breathing without the encumbrances of barriers. That animal, unfortunately, has yet to be created. 

[Emma Schneider]

joe- theres this newish device called numask.  It works pretty well. Ive actually used it on resp arrests.  They have the one way valves with filters and then you can attach a BVM to them.  the only things you gotta remember with them are if the patient vomits or "stuff" comes up from giving to much air you gotta be quick to remove the device (not had to deal with that yet-proper ventilation and that shouldnt happen) and the other thing is that you hafta pinch off the nose, but thats easy to remember.  you dont hafta worry about proper seal, it stays in place while doing compressions and its protection from risks...

 

its a pretty cool little device, so if you get a chance look it up and you may be surprized.

 

 

[Joe Batarse]

Emma, thank you for your response and information on the Numask. I am not familiar with the device. Although I have never used it, I can assume that it is easier to handle than traditional masks. That said my point is that any device (no matter how improved it is) will always be more burdensome than no device. Mouth-to-mouth allows for certainty, based on immediacy, that a seal is achieved that no barrier can ever replicate. This makes mouth-to-mouth more efficacious – but not necessarily “better” as a standard of practice for the obvious reasons. This should not deter the use of the Numask, if in fact it delivers as advertised.

[Ron Arendas]

First of all, to clarify, "universal precautions" are concerned primarily with exposure to blood; we are talking about "standard precautions" or "body-substance isolation precautions,"which concern isolation from all body fluids, including saliva.

Most drowning victims are hypoxic and therefore benefit from measures to provide oxygen, including rescue breathing, CPR, and oxygen administration.The sooner these respiratory measures can be effectively initiated, the more likely that the victim can be stabilized prior to the onset of clinical or biological death. In a water rescue, the delivery of even a few rescue breaths can make the difference between a "live" victim in need of resuscitation and a "clinically dead" victim in need of CPR, AED, and advanced medical care. Barrier devices in water are largely impractical and could even critically delay victim rescue and proper care.

Having said all of this, I would like to emphasize that the risk of contracting a pathogen through mouth-to-mouth contact is very low and mouth-to-nose may even be lower. Obviously, the use of a breathing barrier makes a low risk even lower, but delaying rescue breathing until a barrier device is available may not be justified, given the benefit-to-risk ratio.

The presence of even a very low risk means that the decision to make mouth-to-mouth or mouth-to-nose contact should remain with the rescuer. I certainly know what I would do in the midst of a rescue when there is no apparent breathing. Can you say "do-se-do?"