CPR Works Differently for People Who Overdose, Study Says

Individuals who enter cardiac arrest in connection with an opioid overdose may have better neurologic survival after receiving CPR that includes mouth-to-mouth rescue breaths, as opposed to compression-only CPR, a study published yesterday in JAMA Network Open has found.

If you’ve gotten CPR-certified in the last 15 years, you know that chest compressions have been increasingly prioritized over mouth-to-mouth breathing assistance. International guidance now recommends bystanders initiate compression-only CPR when someone nearby enters cardiac arrest.

But in recent years, some experts and organizations like the American Heart Association have recommended that CPR on someone who has overdosed actually should include those rescue breaths, due to the way overdose can induce respiratory arrest and low levels of oxygen in the blood. But there’s been little to no research to provide evidence for this proposal.

For the new study, researchers analyzed almost 11,000 episodes of cardiac arrest that occurred outside hospitals in British Columbia. CPR including both compressions and breathing was associated with better outcomes in opioid-associated cardiac arrests, but not in other instances of cardiac arrest. More research is needed, and potentially more education — as the authors point out, making CPR recommendations more complicated could potentially mean fewer bystanders will intervene at all.