Life without kissing

Is it the end for the kiss of life? The Mills & Boon, misty focus version of this ancient life-saving technique has little to do with the grim reality of saliva, mouthfuls of partially eaten food and, sorry, vomit. You don’t go into medicine for the glamour, but the truth is, mouth-to-mouth resuscitation is just not very nice. Still, opportunities for resuscitating collapsed individuals do not occur only inside hospitals where a suction device, a plastic airway and an oxygen mask make performing this technique less unpleasant. In the street you will have no such back-up. It is you and the person lying on the pavement, turning blue.

Most people in this position do not get much in the way of cardiopulmonary resuscitation, or CPR, where rhythmic chest compressions are delivered with mouth-to-mouth. Yet CPR saves lives – between 10 and 12 per cent of people who have it will survive to hospital discharge. Only one in three people who are collapsed and pulseless outside hospitals have resuscitation attempted upon them by a member of the public. Why? One reason is the icky one – mouth-to-mouth.

So what if you could do just the chest compressions? Over the past decade, repeated papers have suggested that mouth-to-mouth isn’t all it’s cracked up to be. The idea has been that you need to keep oxygen levels in the patient’s blood high – but of course mouth-to-mouth relies on expelled air, which has a lower oxygen concentration anyway. There is probably enough oxygen present when the patient has collapsed, and efforts should be focused on getting the blood to circulate. Hence the reliance on chest compressions.

Three recent studies support compression-only resuscitation. Two big randomised studies reported in the New England Journal of Medicine showed that compressions alone were just as good as compressions plus mouth-to-mouth. The other paper, from Japan, was in The Lancet. It concentrated on children, who do not collapse, pulseless, for the same reasons that adults do. Where the cause in children was cardiac, mouth-to-mouth made no difference. For other causes – a seizure, choking, asthma – giving mouth-to-mouth did improve survival better than chest compressions alone, and saved more lives than no resuscitation at all.

This is important, because it is easy to teach people to do chest compressions. It is also easier to remember fewer things in an emergency. Why have official guidelines turned a blind eye to the research? Swift change seems necessary.

Margaret McCartney is a GP in Glasgow

margaret.mccartney@ft.com

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