A reappraisal of mouth-to-mouth ventilation during bystander-initiated cardiopulmonary resuscitation. A statement for healthcare professionals from the Ventilation Working Group of the Basic Life Support and Pediatric Life Support Subcommittees, American Heart Association.

Cardiopulmonary resuscitation (CPR) performed by bystanders clearly improves survival of victims of out-of-hospital cardiac arrest and other life-threatening conditions such as drowning and respiratory arrest [1, 2]. However, despite three decades of promulgation, CPR is not performed for the majority of victims who require lifesaving care [3–6]. Studies have identified reticence to perform mouth-to-mouth ventilation as a significant barrier to more frequent performance of bystander CPR [1, 7–13]. In addition to acting as a barrier to initiation of CPR, the mouth-to-mouth ventilation component of CPR may have other adverse effects, such as promoting gastric inflation [14–17]or decreasing the percentage of time allocated to effective chest compression [18–20].