Call to Action: Bystanders, Perform Mouth-to-Barrier Respirations


In emergency medical calls, Paramedics and Emergency Medical Technicians (EMT-B) respond to car accidents, attempted suicides, drug overdoses, and other life-threatening cases. Among these emergencies is a dire situation, cardiopulmonary arrest. A cardiopulmonary arrest episode is spontaneous and usually not foreseeable; however, when the heart and lungs are not properly pumping rich, oxygenated blood throughout the body, vital organs begin to die.

Unfortunately, there are concerns about performing mouth-to-mouth breaths on a stranger. Among these are fears that the volunteer who performs mouth-to-mouth breaths may acquire an infectious disease. Another misconception is that ventilation is simply not necessary. However, chest compressions without ventilation become less effective over time because the blood becomes deoxygenated and is no longer promoting life.  Therefore, mouth-to-barrier ventilation in out-of-hospital cardiopulmonary resuscitation (CPR) is a viable technique to improve survival rates. Although blood supply can be pumped manually throughout the body by performing chest compressions, rescue breaths are just as essential to the resuscitation effort. Without the support of oxygen within the body, a patient holds no chance for survival.

When bystanders exhale rescue breaths into a victim, the victim receives 15% oxygen as compared to the 6% oxygen consumption rate in normal breathing. Rescue breaths provide more than enough oxygenation support for cells in victims. Although survival rates of cardiopulmonary arrest are low, “patients had a 30-day survival rate of 10.9%, as compared with a rate of 15.4% among those who received early CPR,” according to Hasselqvist-Ax et al.1

 Additionally, the belief that an infectious disease can be transmitted through CPR efforts mostly contributes to the doubt and hesitation that leads to a volunteer’s decision to perform only chest compressions. Laypeople should realize that acquiring a saliva-borne disease is unlikely, especially since the purpose of mouth barrier devices is to prevent the transmission of direct person-to-person contact. Furthermore, hands-only CPR is effective only in cases of cardiac arrest, as opposed to cardiopulmonary arrest. It is important to note that when victims suffer from suffocation, drowning, or any other respiratory impeding issue, compression-only CPR is not effective due to the deficient oxygen concentrations already circulating.

Because of growing concerns with delayed Emergency Medical Services (EMS) arrival times, bystanders should administer CPR to increase the chances of survival and reduce the risks associated with hypoxia. Hypoxia is a state of deficient oxygen levels in the blood, which may lead to anoxic brain injuries. According to the American Red Cross, 4 to 6 minutes after cardiac arrest, brain injury is possible. Brain damage is highly likely after approximately 7 minutes. Finally, after 10 minutes without proper circulation, irreversible brain damage is imminent. Even in high-performing EMS systems, the most reasonable response times can vary between 4-6 minutes. However, as urban growth prevails, some arrival times can take up to 10 minutes. Lack of full CPR with mouth-to-barrier respirations greatly jeopardizes the survival rates of these victims.

In complicated medical emergencies, there may not be a correct or perfect solution to an issue such as cardiopulmonary arrest, especially when no mouth barriers are available. CPR instructors and students should promote the use of mouth-to-barrier ventilation in cases of out-of-hospital CPR. All health organizations should also encourage full CPR with mouth-to-barrier respirations when educating laypeople, granted that mouth barriers become more accessible to the public. A person’s life is in the balance. Above all, the promotion of life saving measures is critical to our friends, families, and communities.

Austin Rios is currently a rising second-year student at The University of Texas at Dallas, pursuing a Bachelor’s of Science in Molecular Biology. Austin is an aspiring trauma surgeon. He holds Basic Life Support Provider status with the American Heart Association. Austin would like to recognize Dr. Barbara Morgan, Professor of English at Collin College, for her assistance during the full research paper writing process.


1 Hasselqvist-Ax I, Riva G, Herlitz, J, et al. Early Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest. (The New England Journal of Medicine 2015; 372 (24). 2307-2315.