To BrEath or not to BrEath… That is the question

Background

Since the introduction of CPR, jokes about mouth-to-mouth have been around.  Before COVID the jokes about mouth-to-mouth being compared to kissing and the like were just as popular about the risks of disease transmission, or just a “yuck factor” in general. But COVID was not the crux of the mouth-to-mouth controversy. The discovery of HIV era set mouth-to-mouth back considerably yet it was still in the guidelines when COVID scared us most recently.

Popularity

Everyone has an opinion about mouth-to-mouth, yet most people have not had a recent CPR class. Hollywood capitalizes with comedic relief about mouth-to-mouth. With the opportunity to perform CPR not being very high, it’s surprising how many people have stories to tell about doing mouth-to-mouth. With the advent of small, easy-to-carry, pocket masks and barrier devices, AED stations containing barrier devices of some kind, stories, and old wives’ tales continue to rise. Recently, with the hands-only CPR models, we still get asked the question, “are we still doing mouth-to-mouth?”

Why?

What does mouth-to-mouth, or any breaths with a barrier device, actually do? Providing oxygen to those who need CPR is the simplest answer. Students love showing off their pathophysiology knowledge of respiration, teaching us, the teachers, that we exhale carbon dioxide. We need to take a deep breath, showing off our respiratory skills just so we can continue their education on the respiratory cycle regarding what gases we inhale and what gases we exhale in a respiratory cycle.

Who?

The most important question here is who.  Who needs mouth-to-mouth? People who are not breathing. But we need to ask who again.  Who should be providing people with mouth-to-mouth who need mouth-to-mouth? People who know the victim. Not bystanders.

To put this in a better perspective, we need to stop talking about strangers. Too often, the scenario is a stranger on the street, or something similar. Let’s make it a little more creative. Set the scenario up as, “a crowded family reunion….” The truth is, there are a lot of people at your family reunion many people would not think twice about performing mouth-to-mouth on, but there are just as many people there that would cause them to freeze and start overthinking if they should do mouth-to-mouth on them or not. Strangers are overdone. All of us know too many people close to us who we know we would not do mouth-to-mouth on in an emergency.

We need to start preparing rescuers to understand this before an emergency so they are truly prepared.

The Opposite

Being a rescuer is one thing. Imagine being the victim. When we are the rescuer, we have the luxury of discrimination. Being the victim, lying there helpless, the victim does not care who puts their mouth on them, who exposes their chest, who pushes on it, who pinches their nose, who seals their lips around theirs. They want someone to do it. Anyone. They want those questionable family members to do it they were judging at one time or another.

Concluson

Yes, it is still a big part of CPR. It is important. It can help. It can improve outcomes. But it comes with risk. You need to think about these questions deeply and make up your mind before an emergency occurs.