Mouth-to-mouth resuscitation during Covid – study finds using a face mask works

*Note that this work is presented at the Euroanaesthesia congress in Milan, June 4-6. Please credit Congress when using this story**

New research presented at the European Society of Anaesthesiology and Intensive Care (ESAIC) annual meeting in Milan, Italy (June 4-6) shows that learning to practice mouth- mouth while wearing a face mask to reduce the risk of transmission of COVID-19.

Mouth-to-mouth ventilation, in which the rescuer presses their mouth against the patient’s mouth and blows air into their lungs, is an integral part of basic life support for adults and children. Along with chest compressions, it forms cardiopulmonary resuscitation (CPR).

At the start of the COVID-19 pandemic, CPR training in the Czech Republic and elsewhere was limited to either chest compressions-only courses (hands-only CPR) or bag-mask ventilation courses, due to concerns about infection. In this case, the rescuer uses a manual resuscitator (a self-inflating bag held in the hand), rather than their mouth to blow air into the patient’s lungs.

This ensures that professionals, such as medical personnel and firefighters, receive sufficient training. However, lay rescuers do not have access to resuscitation equipment when performing CPR and must still learn the mouth-to-mouth method.

Medical students can also normally learn mouth-to-mouth resuscitation for use in out-of-hospital emergencies.

In an attempt to fill the training gap, Dr Vaclav Vafek, from the Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Brno, Czech Republic, and his colleagues investigated whether word of mouth mouth while wearing a breathable face mask.

The mask used was a self-sterilizing reusable respirator FFP2 with three layers of nanofibers.

In the May 2021 crossover study, 104 medical students performed mouth-to-mouth ventilation while wearing the ventilator for two minutes on each of three manikins (two adult manikins, adult BLS manikin and Resusci Anne, and one child manikin, Resurrected Baby).

Trained observers evaluated each inflation. Over 90% of the mouth breaths for each manikin were found to be effective, i.e., they resulted in the manikin’s chest rising. (BLS adult manikin, 96.9% or 951/981 breaths, Resusci Anne, 90.7% or 822/906 breaths, Resusci Baby, 95.7% or 1,777/18.57 breaths).

The researchers also used an app to measure the volume of air breathed into the Resusci Anne and Resusci Baby mannequins.

The volume was optimal (400-600 ml for Resusci Anne and 30-50 ml for Resusci Baby) in 33% of Resusci Anne artificial respirations and 44% of Resusci Baby artificial respirations.

28.9%/15.9% (Resusci Anne/Resusci Baby) of breaths were below optimal volume and 28.8%/35.8% were above optimal volume.

The researchers conclude: “Mouth-to-mouth ventilation through a breathable respirator was effective more than 90% of the time, enabling its use in high-quality basic resuscitation training during the pandemic.

Dr. Vafek adds: “Since then, we have successfully used respirators in first aid exercises in our undergraduate programs in medicine and dentistry.

“We cannot predict the severity of the pandemic in the fall and what the COVID-19 measures will look like then. However, with this technique, we will be able to continue providing life-saving training in mouth-to-mouth resuscitation.

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