Mouth-to-mouth resuscitation

Mouth-to-mouth resuscitation, a form of artificial

ventilation, is the act of assisting or stimulating respiration in
Mouth-to-mouth resuscitation
which a rescuer presses their mouth against that of the victim
and blows air into the person's lungs.[1][2] Artificial
respiration takes many forms, but generally entails providing
air for a person who is not breathing or is not making
sufficient respiratory effort on their own.[3] It is used on a
patient with a beating heart or as part of cardiopulmonary
resuscitation (CPR) to achieve the internal respiration.

Pulmonary ventilation (and hence external respiration) is

achieved through manual insufflation of the lungs either by
the rescuer blowing into the patient's lungs, or by using a
Mouth-to-mouth insufflation
mechanical device to do so. This method of insufflation has
been proved more effective than methods which involve ICD- 93.93 (http://icd9cm.chrisendres.co
mechanical manipulation of the patient's chest or arms, such 9-CM m/index.php?srchtype=procs&srchte
as the Silvester method.[4] It is also known as expired air xt=93.93&Submit=Search&action=se
resuscitation (EAR), expired air ventilation (EAV), rescue arch)
breathing, or colloquially the kiss of life. It was introduced
MeSH D012121
as a life saving measure in 1950.[5]

Mouth-to-mouth resuscitation is a part of most protocols for performing cardiopulmonary resuscitation

(CPR)[6][7] making it an essential skill for first aid. In some situations, mouth-to-mouth resuscitation is also
performed separately, for instance in near-drowning and opiate overdoses. The performance of mouth-to-
mouth resuscitation on its own is now limited in most protocols to health professionals, whereas lay first-aiders
are advised to undertake full CPR in any case where the patient is not breathing sufficiently.

Contents
History
Insufflations
Adjuncts to insufflation
Efficiency of mouth-to-patient insufflation
Oxygen
See also
References
External links

History
In 1773, English physician William Hawes (1736–1808) began publicising the power of artificial respiration to
resuscitate people who superficially appeared to have drowned. For a year he paid a reward out of his own
pocket to any one bringing him a body rescued from the water within a reasonable time of immersion. Thomas
Cogan, another English physician, who had become interested in the same subject during a stay at Amsterdam,
where was instituted in 1767 a society for preservation of life from accidents in water, joined Hawes in his
crusade. In the summer of 1774 Hawes and Cogan each brought fifteen friends to a meeting at the Chapter
Coffee-house, St Paul's Churchyard, where they founded the Royal Humane Society as a campaigning group
for first aid and resuscitation.[8]

Gradually, branches of the Royal Humane Society were set up in other parts of the country, mainly in ports
and coastal towns where the risk of drowning was high and by the end of the 19th century the society had
upwards of 280 depots throughout the UK, supplied with life-saving apparatus. The earliest of these depots
was the Receiving House in Hyde Park, on the north bank of the Serpentine, which was built in 1794 on a site
granted by George III. Hyde Park was chosen because tens of thousands of people swam in the Serpentine in
the summer and ice-skated in the winter. Boats and boatmen were kept to render aid to bathers, and in the
winter ice-men were sent round to the different skating grounds in and around London.

The society distributed money-rewards, medals, clasps and testimonials, to those who saved or attempted to
save drowning people. It further recognized "all cases of exceptional bravery in rescuing or attempting to
rescue persons from asphyxia in mines, wells, blasting furnaces, or in sewers where foul gas may endanger
life."[8]

Insufflations
Insufflation, also known as 'rescue breaths' or 'ventilations', is the act
of mechanically forcing air into a patient's respiratory system. This
can be achieved via a number of methods, which will depend on the
situation and equipment available. All methods require good airway
management to perform, which ensures that the method is effective.
These methods include:

Mouth-to-mouth - This involves the rescuer making a seal

between his or her mouth and the patient's mouth and
'blowing', to pass air into the patient's body
Mouth-to-nose - In some instances, the rescuer may need
or wish to form a seal with the patient's nose. Typical
reasons for this include maxillofacial injuries, performing
the procedure in water or the remains of vomit in the mouth
Mouth-to-mouth and nose - Used on infants (usually up to
around 1 year old), as this forms the most effective seal
Mouth-to-mask – Most organisations recommend the use of Typical view of resuscitation in
some sort of barrier between rescuer and patient to reduce progress with an Ambu bag in use
cross infection risk. One popular type is the 'pocket mask'. ("bagging").
This may be able to provide higher tidal volumes than a
Bag Valve Mask.[9]

Adjuncts to insufflation

Most training organisations recommend that in any of the methods involving mouth-to-patient, that a protective
barrier is used, to minimise the possibility of cross infection (in either direction).[10]
Barriers available include pocket masks and keyring-sized face
shields. These barriers are an example of personal protective
equipment to guard the face against splashing, spraying or splattering
of blood or other potentially infectious materials.[11]

These barriers should provide a one-way filter valve which lets the air
from the rescuer deliver to the patient while any substances from the
patient (e.g. vomit, blood) cannot reach the rescuer. Many adjuncts are
single use, though if they are multi use, after use of the adjunct, the
mask must be cleaned and autoclaved and the filter replaced. It is very A CPR pocket mask, with carrying
important for the mask to be replaced or cleaned because it can act as case
a transporter of various diseases.

The CPR mask is the preferred method of ventilating a patient when only one rescuer is available. Many
feature 18 mm (0.71 in) inlets to support supplemental oxygen, which increases the oxygen being delivered
from the approximate 17% available in the expired air of the rescuer to around 40-50%.[12]

Efficiency of mouth-to-patient insufflation

Normal atmospheric air contains approximately 21% oxygen when inhaled. After gaseous exchange has taken
place in the lungs, with waste products (notably carbon dioxide) moved from the bloodstream to the lungs, the
air being exhaled by humans normally contains around 17% oxygen. This means that the human body utilises
only around 19% of the oxygen inhaled, leaving over 80% of the oxygen available in the exhalatory
breath.[13]

This means that there is more than enough residual oxygen to be used in the lungs of the patient, which then
enters the blood.

Oxygen
The efficiency of artificial respiration can be greatly increased by the simultaneous use of oxygen therapy. The
amount of oxygen available to the patient in mouth-to-mouth is around 16%. If this is done through a pocket
mask with an oxygen flow, this increases to 40% oxygen. If either a bag valve mask or a mechanical ventilator
is used with an oxygen supply, this rises to 99% oxygen. The greater the oxygen concentration, the more
efficient the gaseous exchange will be in the lungs.[14]

See also
Mechanical ventilation - using mechanical devices to assist or replace spontaneous breathing
Medical emergency

References
1. "Definition of mouth-to-mouth resuscitation" (https://www.merriam-webster.com/dictionary/mout
h-to-mouth%20resuscitation). Merriam-Webster Dictionary. Retrieved 4 February 2021.
2. Tortora, Gerard J; Derrickson, Bryan (2006). Principles of Anatomy and Physiology. John Wiley
& Sons Inc.
 3. "Artificial Respiration" (http://www.britannica.com/eb/article-9009713/artificial-respiration).
Encyclopædia Britannica. Archived (https://web.archive.org/web/20070614094502/http://www.b
ritannica.com/eb/article-9009713/artificial-respiration) from the original on 14 June 2007.
Retrieved 2007-06-15.
4. "Artificial Respiration" (https://web.archive.org/web/20040104022448/http://encarta.msn.com/e
ncyclopedia_761562617/artificial_respiration.html). Microsoft Encarta Online Encyclopedia
2007. Archived from the original (https://encarta.msn.com/encyclopedia_761562617/Artificial_
Respiration.html) on 2004-01-04. Retrieved 2007-06-15.
5. Stathis Avramidis, Facts, Legends and Myths on the Evolution of Resuscitation, page 27 (http
s://www.academia.edu/1613073/Facts_Legends_and_Myths_on_the_Evolution_of_Resuscitat
ion)
6. "Decisions about cardiopulmonary resuscitation model information leaflet" (https://web.archive.
org/web/20070705043458/http://www.bma.org.uk/ap.nsf/Content/cprleaflet). British Medical
Association. July 2002. Archived from the original (http://www.bma.org.uk/ap.nsf/Content/cprlea
flet) on 2007-07-05. Retrieved 2007-06-15.
7. "Overview of CPR"
(https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.105.166552). American Heart
Association. 2005. doi:10.1161/CIRCULATIONAHA.105.166552 (https://doi.org/10.1161%2FCI
RCULATIONAHA.105.166552). Retrieved 4 February 2021.
8. One or more of the preceding sentences incorporates text from a publication now in the public
domain: Chisholm, Hugh, ed. (1911). "Humane Society, Royal". Encyclopædia Britannica
(11th ed.). Cambridge University Press.
9. Dworkin, Gerald M (Winter 1987). "Mouth-to-Mask rescue breathing and comparisons of
personal resuscitation masks" (https://web.archive.org/web/20070602124950/http://lifesaving.c
om/issues/articles/30mouth_to_mouth.html). Rescue Squad Quarterly. Archived from the
original (http://www.lifesaving.com/issues/articles/30mouth_to_mouth.html) on 2007-06-02.
Retrieved 2007-06-15.
10. "Emergency Cardiovascular Care Revisions for the professional rescuer" (http://www.redcross.
org/services/hss/resources/eccpr.doc) (DOC). American Red Cross. Retrieved 2007-06-15.
11. Verbeek, Jos; Ijaz, Sharea; Tikka, Christina; Ruotsalainen, Jani; Mäkelä, Erja; Neuvonen,
Kaisa; Edmond, Michael; Sauni, Riitta; Kilinc Balci, FSelcen (April 2018). "303 Personal
protective equipment for preventing highly infectious diseases due to exposure to contaminated
body fluids in healthcare staff" (https://doi.org/10.1136%2Foemed-2018-icohabstracts.500).
Health Services Research. BMJ Publishing Group: A177.1–A177. doi:10.1136/oemed-2018-
icohabstracts.500 (https://doi.org/10.1136%2Foemed-2018-icohabstracts.500).
12. Handley, Anthony J.; Becker, Lance B.; Allen, Mervyn; Drenth, Ank van; Kramer, Efraim B.;
Montgomery, William H. (15 April 1997). "Single-Rescuer Adult Basic Life Support" (http://circ.a
hajournals.org/content/95/8/2174). Circulation. 95 (8): 2174–2179.
doi:10.1161/01.CIR.95.8.2174 (https://doi.org/10.1161%2F01.CIR.95.8.2174). ISSN 0009-7322
(https://www.worldcat.org/issn/0009-7322). PMID 9133531 (https://pubmed.ncbi.nlm.nih.gov/91
33531).
13. "Physical Intervention: Life Support (Rescue Breathing)" (https://web.archive.org/web/2006012
5011006/http://www.doitnow.org/pages/208/208-5.html). Archived from the original (http://www.
doitnow.org/pages/208/208-5.html) on 25 January 2006. Retrieved December 29, 2005.
14. Petersson, J.; Glenny, R. W. (25 July 2014). "Gas exchange and ventilation-perfusion
relationships in the lung" (https://doi.org/10.1183%2F09031936.00037014). European
Respiratory Journal. 44 (4): 1023–1041. doi:10.1183/09031936.00037014 (https://doi.org/10.11
83%2F09031936.00037014). PMID 25063240 (https://pubmed.ncbi.nlm.nih.gov/25063240).

External links
Expired Air Resuscitation (http://www.justincase.com.au/ear.html)
 Basic first aid advice from the Australian New South Wales ambulance service (https://web.arc
hive.org/web/20091030015710/http://www.ambulance.nsw.gov.au/docs/firstaid/080430cpr.pdf)
Two page pamphlet detailing EAR (https://web.archive.org/web/20070316092433/http://www.h
ealth.qld.gov.au/phs/Documents/shpu/12413.pdf)
UK resuscitation council website - contains information on the latest approved guidelines (htt
p://www.resus.org.uk)

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