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Original Research

Open Access

Is mouth-to-mouth ventilation effective in first responders? Comparing the effects between 30 : 2 algorithm versus hands-only. An exploratory pilot simulation study

  • Maria José Pujalte-Jesús1
  • José Luis Díaz Agea1
  • César Leal-Costa2

1Official Masters in Emergency and Special Care Nursing, Faculty of Nursing, Catholic University of Murcia, Murcia, Spain

2Faculty of Nursing, University of Murcia, Murcia, Spain

DOI: 10.22514/sv.2020.16.0062 Vol.17,Issue 2,March 2021 pp.132-138

Published: 08 March 2021

*Corresponding Author(s): José Luis Díaz Agea E-mail:


Aim: Compare which resuscitation (for cardiac arrest scenario) has a higher quality when first responders with a duty of care are deprived of material: a standard resuscitation algorithm or a hands-only one when performed by first responders with training on mouth-to-mouth ventilation. Besides, a more specifics objectives were: to analyze the characteristics of these mouth-to-mouth ventilations and study the association between Body Mass Index and the different variables related to compressions.

Methods: We conducted a prospective quasi-experimental crossover study of consecutive standardized simulated cases with 41 volunteers attached to the Plan of Surveillance and Rescue in Beaches. Each participant performed 2 minutes of basic life support (CPRb). Afterward, each participant performed 2 minutes of CPR with hands-only (CPRho). The data collection was carried out with a CPR calibrated Mannequin.

Results: The mean depth was 48.1 ± 9.0 mm for CPRb, and 44.8 ± 9.7 mm for CPRho (t = 5.8, P < 0.001, 95% CI, 2.2 - 4.4), the rate was 123 ± 16.1 compressions/min for CPRb and 120 ± 17.9 for CPRho. The CPRho achieved a mean of 106 ± 42.5 complete compressions with full chest recoil, versus 57 ± 55.3 for CPRb (z = -2.6, P = 0.009). 20.7% of ventilation were hypoventilation and 42.7% were hyperventilation.

Conclusions: Mouth-to-mouth ventilations performed by first responders during simulated scenario not met European Resuscitation Council guideline based targets to ventilation, despite being performed by well-trained providers. When ventilations were not performed, the number of high-quality compressions increased in absolute values.


Cardiopulmonary resuscitation; Simulation; Chest compression; Basic life support; Hands-only

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Maria José Pujalte-Jesús,José Luis Díaz Agea,César Leal-Costa. Is mouth-to-mouth ventilation effective in first responders? Comparing the effects between 30 : 2 algorithm versus hands-only. An exploratory pilot simulation study. Signa Vitae. 2021. 17(2);132-138.


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