Resuscitation Council (UK)

Cardiopulmonary resuscitation

Training in mouth-to-mouth ventilation

Resuscitation Council (UK) Guidelines 2015 include mouth-to-mouth ventilation during cardiopulmonary resuscitation (CPR) for both laypeople and healthcare professionals. Starting resuscitation with compression-only CPR is encouraged for those who are untrained, or unable to perform mouth-to-mouth ventilation, or when there are clinical reasons for avoiding mouth-to-mouth contact. Compression-only CPR is better than no CPR, and this is the primary message in high-profile media campaigns in the UK that target people who have not been trained in CPR.

Studies have shown that compression-only CPR may be as effective as combined ventilation and compression in the first few minutes after non-asphyxial arrest. However, chest compression combined with ventilation is the method of choice for CPR by trained lay-rescuers and professionals and should be the basis for lay-rescuer education.

Compression-only CPR has potential advantages over chest compression and ventilation, particularly when the rescuer is an untrained or partially-trained layperson. However, there are situations where combining chest compressions with ventilation is better, for example in children, in asphyxial arrests, and in prolonged resuscitation attempts. Therefore, CPR with ventilation should remain standard care for healthcare professionals and the preferred target for laypeople, the emphasis always being on minimal interruption in chest compressions. A simple, education-based approach is recommended:
  • Ideally, full CPR skills should be taught to all citizens.
  • Initial or limited-time training should always include chest compression.
  • Subsequent training (which may follow immediately or at a later date) should include ventilation as well as chest compression.

CPR training for citizens should be promoted, but untrained laypeople should be encouraged to give chest compressions only, when appropriate with telephone advice from an ambulance dispatcher.

Those laypeople with a duty of care, such as first-aid workers, lifeguards, and childminders, should be taught chest compression and ventilation.

Resuscitation Council (UK) Guidelines 2015 for ‘In-hospital resuscitation’ state 'There are usually good clinical reasons to avoid mouth-to-mouth ventilation in clinical settings, and it is therefore not commonly used, but there will be situations where giving mouth-to-mouth breaths could be life-saving (e.g. in non-clinical settings). If there are clinical reasons to avoid mouth-to-mouth contact, or you are unable to do this, do chest compressions until help or airway equipment arrives. A pocket mask or bag-mask should be immediately available in all clinical areas.

Current guidelines recommend starting CPR with chest compressions and this helps avoid the need for mouth-to-mouth resuscitation in most clinical situations as airway equipment should be available rapidly. The Resuscitation Council (UK) recognises that there will be circumstances where mouth-to-mouth ventilation is not appropriate. But there are occasions when giving mouth-to-mouth ventilation could be life-saving.

Mouth-to-mouth ventilation is an important resuscitation skill that is relatively easy to teach and learn, and should be included in resuscitation training for healthcare professionals.

March 2016
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