COMMENT

The patients described here with respiratory arrest or imminent respiratory arrest were resuscitated by chest compression.

During an asthmatic attack the inspiratory effort is greater than the ability to expel air from the lungs and maximum inspiratory volume is reached. There is then rapid deterioration and exhaustion. It thus seems logical to use one’s own strength to help the patient breathe out and the change in respiratory pattern is dramatic. The Schafer and Holger-Nielson methods of artificial respiration have been largely superseded by mouth to mouth respiration because it was believed to be more efficient.

In asthma the chest wall is already fully expanded. One would not attempt to further expand a bellows if it was already fully expanded, which is what is being attempted when mouth to mouth or ventilators are used in this situation.

There is a general assumption that mouth to mouth artificial respiration if used would be the most effective method of resuscitation. There is no evidence for this and I have yet to hear of a case or see a description in the literature of a successful outcome with one exception. Some years ago I saw a American documentary film on one of the UK television channels. It was a reconstruction of a resuscitation following cessation of breathing in a boy with severe asthma in the USA. The purpose of the film was to demonstrate the value of a telephone advice from a hospital to patients in isolated areas. The scene switched repeatedly from a doctor or nurse giving instructions on mouth to mouth ventilation to a distraught father trying to revive his son. After each attempt at mouth to mouth the Father lifted the child off the floor and gave him an exaggerated bear hug embrace pressing the child’s chest against his own. He did this continuously and dramatically and I am sure he sensed and probably heard the expiration after each hug and realised he had to continue. The reconstruction apparently was very accurate but was the successful outcome due to the mouth to mouth or the chest compression?

There is other anecdotal evidence that chest compression after breathing has stopped can be effective in saving life: the more violent Heimlich’s Manoeuvre in which it is suggested that the mucus is forced from the bronchi to clear the airways, although this is pure supposition. In this manoeuvre the pressure is applied to the epigastrium and therefore less effective in expelling air from the lungs than firm pressure on the lower ribs during expiration.

I would be interested to hear from anyone associated with this film or from anyone who has dealt with respiratory arrest associated with asthma. I would also like to hear from patients who have used this or similar techniques during asthmatic attacks.