Why They Matter for Saving Lives
When a person suffers a cardiac arrest, every second counts. Immediate intervention can mean the difference between life and death, which is why Cardiopulmonary Resuscitation (CPR) is a critical skill that everyone should know. While chest compressions are often highlighted as the most important (which they are), rescue breaths are equally important in certain situations. This blog post will delve into the significance of rescue breaths, explore when they should and should not be administered, and provide insights into their role within First Aid guidelines.
Understanding the Chain of Survival
The Chain of Survival is a concept introduced by the European Resuscitation Council (ERC) to describe the critical steps required to improve survival rates in cases of sudden cardiac arrest. The Chain of Survival consists of the following links:
1. Early recognition and call for help:
Recognising the signs of cardiac arrest (Unresponsive and not breathing normally) and immediately calling emergency services is crucial.
2. Early CPR:
Initiating CPR as soon as possible to maintain blood flow to vital organs, especially the brain.
3. Early defibrillation:
Applying an Automated External Defibrillator (AED) to restore a normal heart rhythm.
4. Post-resuscitation care:
Ensuring the casualty receives appropriate care after resuscitation, including advanced medical treatment.
Rescue breaths play a vital role in the second link of this chain—early CPR. While chest compressions are essential for maintaining circulation, rescue breaths help oxygenate the blood. This is especially crucial in cases where the cardiac arrest is not due to a primary heart condition, such as drowning or asphyxiation.
The Chain of survival is taught on all of our first aid courses where we cover CPR.
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The Role of Rescue Breaths in CPR
Rescue breaths are designed to inflate the lungs, delivering oxygen to the blood, which the heart then pumps to the rest of the body. When the heart stops, so does breathing, leading to a rapid depletion of oxygen in the blood. Without rescue breaths, the brain and other vital organs begin to suffer from hypoxia (lack of oxygen), which can result in irreversible damage within minutes.
Survival Rates and Rescue Breaths:
Statistics show that the combination of chest compressions and rescue breaths increases the likelihood of survival, particularly in situations where oxygen deprivation is the primary cause of cardiac arrest. According to studies*, when bystanders provide CPR with rescue breaths, survival rates can be as high as 30-40% in cases of witnessed cardiac arrest with a shockable rhythm. This is a significant increase compared to survival rates for those who receive chest compressions alone in non-heart-related cases, such as drowning or respiratory failure, where oxygen levels are critically low.
Chest Compressions Only
While rescue breaths are important, there are specific scenarios where chest-compression-only CPR is recommended:
1. Untrained Rescuers:
If a bystander is not trained in CPR, the ERC advises performing chest compressions only. This simplifies the process and increases the likelihood that the bystander will take action rather than hesitating due to a lack of knowledge about rescue breaths.
2. Adult Cardiac Arrest from a Cardiac Cause:
In cases where an adult has suffered a cardiac arrest due to a heart-related issue (like a heart attack), chest-compression-only CPR is often sufficient in the first few minutes, as the blood typically has enough residual oxygen. The priority is to maintain circulation until professional help arrives.
3. Pandemic Considerations:
During the COVID-19 pandemic, rescue breaths were temporarily removed from standard CPR guidelines for the general public to minimise the risk of viral transmission. Bystanders were encouraged to perform hands-only CPR with continuous chest compressions to reduce exposure risk.
If you are unwilling or unable to perform rescue breaths on a casualty, maybe due to facial wounds, infection risk, lack of PPE, fear or your own personal issues, it is still much better to do something rather than nothing. Therefore, chest compressions only will give the casualty a much greater chance of survival instead of nothing at all.
The COVID-19 Pandemic and Rescue Breaths
The COVID-19 pandemic brought unprecedented challenges, including the need to modify CPR guidelines temporarily. To protect both first aiders and casualties from potential infection, health authorities recommended that bystanders perform chest compressions only, without rescue breaths, unless they had access to personal protective equipment (PPE). This was a temporary measure intended to balance the need to save lives with the importance of reducing the spread of the virus.
Now that the pandemic is under control in many parts of the world, rescue breaths have been reintroduced into CPR guidelines where appropriate. The return of rescue breaths underscores their importance, particularly in cases of respiratory-related cardiac arrests, such as drowning or drug overdoses, where oxygen deprivation is the primary issue.
Conclusion
Rescue breaths are a critical component of effective CPR, especially in cases where oxygen deprivation is the underlying cause of cardiac arrest. While there are scenarios where chest-compression-only CPR is appropriate—such as during the COVID-19 pandemic or when performed by untrained bystanders—rescue breaths should not be overlooked. The combination of chest compressions and rescue breaths can significantly increase survival rates, providing oxygenated blood to vital organs until professional medical help arrives.
By understanding when and how to administer rescue breaths, and recognising their importance in the Chain of Survival, bystanders can play a crucial role in saving lives. As we move forward, it’s essential to continue educating the public, workplaces and first aiders on the full scope of CPR, ensuring that as many people as possible are equipped to act in an emergency.
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*The specific statistics mentioned in the statement—where survival rates can be as high as 30-40% in cases of witnessed cardiac arrest with a shockable rhythm when CPR with rescue breaths is provided—are generally based on findings from various studies and meta-analyses conducted over the years. These studies typically analyse the effectiveness of bystander CPR in improving survival rates, with a focus on comparing outcomes between CPR with rescue breaths and chest-compression-only CPR.
Some key studies and sources that discuss survival rates and the impact of CPR methods include:
1. The Resuscitation Outcomes Consortium (ROC) Study: This large-scale study involved multiple sites across North America and provided critical data on the survival rates of out-of-hospital cardiac arrests. It highlighted the effectiveness of CPR with rescue breaths in improving survival rates in certain cases, especially when the cardiac arrest is witnessed and involves a shockable rhythm.
2. The 2015 AHA Guidelines Update for CPR and ECC: Published in *Circulation*, these guidelines provide comprehensive data on survival rates based on various CPR interventions. The guidelines emphasise that the combination of chest compressions and rescue breaths improves survival, particularly in scenarios where the arrest is due to asphyxiation or in paediatric cases.
3. European Resuscitation Council (ERC) Guidelines: The ERC guidelines also reference several studies that indicate higher survival rates when both chest compressions and rescue breaths are used, particularly in witnessed cardiac arrests with shockable rhythms.
4. Observational Studies: Various observational studies have analysed large databases of cardiac arrest cases, such as the CARES (Cardiac Arrest Registry to Enhance Survival) database. These studies consistently show that survival is generally higher when bystanders perform CPR with rescue breaths in certain situations.
The survival rate of 30-40% for witnessed cardiac arrests with a shockable rhythm and the provision of rescue breaths aligns with the data from these studies and guidelines, though exact percentages can vary slightly depending on the specific population and study design.
To refer to specific studies, you might want to look into:
Nielsen N, et al. (2013). “Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest” published in NEJM.* Although this study primarily focuses on post-resuscitation care, it provides valuable context on survival outcomes.
Perkins GD, et al. (2015). “European Resuscitation Council Guidelines for Resuscitation 2015” published in Resuscitation.* This paper discusses the impact of various CPR techniques on survival rates.
These references provide a solid foundation for the statistics mentioned and highlight the importance of rescue breaths in CPR.
For further information and research, take a look at