Should unresponsive overdose victims receive rescue breaths or chest compressions from lay bystanders?
If a person is apneic but not in cardiac arrest, failing to give rescue breaths may lead this person to fall into cardiac arrest.
But, if the person is apneic and in cardiac arrest, failure to do quality chest compressions, will lead to their death.
This is a difficult question that we debated in our opioid overdose working group last year. We chose to follow the American Heart Association standards and tell lay rescuers to do chest compressions in apneic patients rather than attempting rescue breathing.
Chest compressions-only are simple, easy to learn, and backed by science.
I like the chest compression for the lay public because:
Chest compressions while providing some circulatory support also provide passive ventilation. *
Chest compressions are also a great stimulus to revive someone from an apneic state.
Most people don’t do rescue breathing very well.
The Ontario Canada Ministry of Health debated the same question and has decided to abandon the AHA standard and instead teach rescue breaths. Lay people are now taught rescue breaths, but are given the choice to perform rescue breaths and/or cardiac compressions.
An article on the Canadian CBC News website, Ontario makes controversial change on how to help overdose victims, does a nice job detailing the debate up there.
Here is some other info on the debate:
Should the public be trained to do CPR on overdose victims?
Evidence Brief: Evidence on rescue breathing or chest compressions in local naloxone programs
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Having voted on the compression only side, the truth is most of the unresponsive overdose patients I respond to are unresponsive and have pulses. These people clearly could benefit from rescue breathing from bystanders. (Some of the unresponsives I respond to are dead and only a few of these are recoverable).
Unfortunately the one size fits all training is probably not the best approach. I think, given the stakes, it is probably worth teaching the willing-to-learn lay person a tiered approach.
Here’s how that would work: If you can’t remember what to do or are uncomfortable doing something, at the least, do chest compressions. If you want to check for a pulse and can find one and are reasonably certain the patient is not dead, do rescue breathing if you have a face mask. If you work in a setting where people overdose frequently (halfway house for example) or if a family member of yours is an opioid user, learn how to use a bag-valve mask and have one on hand next to your naloxone.
Bagging may not be the easiest skill to acquire, but if people have a reasonable belief they may need to use it someday to save someone they care about it, we should make certain training is made available to them, as well as opportunities to practice this life-saving skill.
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* Here is a capnography strip that shows passive ventilation during CPR.
