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Would You Kiss A Stranger: CPR without mouth-to-mouth

Introduction

This First Aid Insight explores compression-only or hands-only CPR. This is where the so-called ‘kiss of life’ is not used. Instead, the technique involves continuous chest compressions. Let’s start with a scenario so you can understand why it is important to know about this technique.

Close up of an elderly woman framing her nose and lips. She is wearing lipstick, which can be off-putting for some when it comes to standard CPR.

There can sometimes be barriers to being able to give an effective rescue breath.

First Responder Scenario

So, imagine this. One morning, taking a stroll in your local park, you see someone collapse. They fall hard, with no warning. Your first aid training clicks in. Automatically, you find yourself checking for danger. It looks safe to approach. You call out, “Hello, can you hear me?” Nothing. You shake their shoulders. No response.

You look, listen and feel for signs of respiration for ten seconds, but it’s clear that they are not breathing. Quickly checking your casualty, you decide that there is no major bleeding or other obvious complications. You take out your phone, dial 999 and you put it on the speaker setting.

The call handler asks you what your emergency is. “I’ve got a non-breathing, unresponsive casualty.” you say and part of you has no idea how you remembered that particular phrase, but there it is. She takes your location and encourages you to begin CPR immediately. Is it your imagination or has the stranger’s lips already gone a bit blue?

An elderly man with a walking stick walks near a park.

If you saw this man fall and stop breathing, what would you do?

Moment of Truth

You begin to panic. There’s no one else in the park as far as you can see. You shout out, “Can I have some help over here, please?” as loud as you can just in case, but no one answers. It’s all down to you.

As it happens, you did your most recent first aid training not too long ago. You know what you ought to do. You remember the head tilt/ chin lift, the nostril pinch, the two effective rescue breaths and just how deep and fast to do those 30 chest compressions.

But here’s the thing. While you were a star student on the CPR manikin, this feels so different. You freeze up. Perhaps some bodily fluid is putting you off – blood, vomit, spit, phlegm – or simply the idea of putting your mouth against a stranger’s beard, stubble or lipstick. Urgghh. Maybe you even fear infection? Whatever might be going on, you are clear about one thing: you are absolutely-not-at-all going to actually put your mouth on their mouth.

An older gentleman - with a moustache and some missing teeth. Would you use hands only CPR or compressions and rescue breaths?

Would you use hands-only CPR or standard CPR?


A Real Dilemma

It’s a dilemma because it’s drummed into you that CPR could save this person’s life. You feel awful, but you can’t change how you feel. However, before you run off and leave this poor person to their fate, there’s another option (which the call handler will remind you about): hands-only CPR.


What is Hands-Only CPR? Is it enough?

Hands-only CPR (also known as compression-only CPR) is simple. You push hard and fast in the middle of the person’s chest at a rate of 100-120 bpm. We know that standard CPR addresses both circulation (compressions) and oxygenation (rescue breaths). So, will the compression-only technique be enough?

It could be. In many adults who suffer a cardiac arrest, the heart stops abruptly; breathing will have been normal (or nearly normal) up until then, so the blood should be well oxygenated. In this situation, compression-only CPR may be effective for the first few minutes after the heart stops. This may provide time for the emergency services to arrive or an AED to be collected. 

Read our Insight to discover just how important AEDs are following a cardiac arrest.

 

The Odds Drop Significantly After The First Few Minutes.

Yes, compression-only CPR could be as effective as standard, ventilated CPR for only the first few minutes. However, ultimately, the oxygen will be used up and rescue breaths are required to give the victim the best chance of resuscitation. Spontaneous return of circulation (when the heart restarts) is not uncommon after ten or twenty minutes. A study involving rats showed that frequent, effective ventilation (rescue breaths or using a bag-valve-mask or BVM) to add air into the lungs saves three times as many lives compared to hands-only CPR or where there was hardly any ventilation. Poor ventilation might be unintentional – due to an issue with the BVM, rescuers forgetting to do rescue breaths while they concentrate on other elements or becoming too tired.

So, if you can manage full CPR, that is the best option for the person you are trying to help. Over 10-20 minutes, you are increasing survival rates three-fold.

 

The Advantages of Hands-Only CPR

Are there any advantages to hands-only CPR? Yes, it is a good alternative for someone who is unwilling to do ‘mouth to mouth’. It is simple and allows the person to focus on doing really effective chest compressions without losing their rhythm. Importantly, it is much more likely to be attempted by someone who has not had any first aid training. Even if it isn’t so good after the first few minutes, hands-only CPR really is better than doing nothing.

It is worth noting that even standard CPR does not provide enough oxygen on its own to completely avoid the adverse health affects of oxygen deficiency. Its main job is to circulate the oxygen already in the body. We are ultimately looking for the spontaneous return of circulation, for the heart to take over the job we have been attempting as rescuers. 

One hand interlocks another on the chest of someone lying on the floor.

Those who have never been taught CPR may feel more confident giving hands-only CPR a go.

When Not to Use Hands-Only (also known as Compression-Only) CPR:

There are times when hands-only CPR is not enough and it’s important to know when this is.

  • If you find someone who has not been breathing for longer than a few minutes
  • If someone was struggling with breathing before they needed CPR
  • If someone drowned and then needed CPR
  • In children, just because this is most likely going to be due to a respiratory issue

In all of these cases, rescue breaths would be needed.


Conclusion

Well done! You did your hands-only CPR and the paramedics arrived and took over. You survived your scenario.

But what about the stranger in the park? It feels a bit cruel not to let you know what happened! The truth is that it can be hard to calculate survival rates, but you started CPR early, which gives them the best possible chance of survival. If the ambulance comes quickly or someone shows up unexpectedly with an AED (who knows, maybe someone saw you from their flat), their chances are good. It’s really thanks to you that they have some kind of chance. 

What can we conclude about hands-only CPR as a first aid technique? If something stops you from performing standard CPR, it’s good to know that hands-only CPR can be just as good for the first few minutes after the heart stops, assuming the casualty was breathing normally beforehand. 

 

Afterthoughts

Hankering after more first aid scenarios? You could check out the Lifesaver App where you can have a go at four realistic scenarios. It is exciting and will give you feedback about whether your efforts made a difference.

Or…. why not challenge yourself with our 16 hour Level 3 Outdoor Pursuits or  First Responders on Scene (FROS)?  These longer first aid courses offer more scope to discuss the different options facing the first responder. We introduce plenty of scenarios that encourage you to really think on your feet!