by Professor R. C. Browne

There are three important types of men concerned with the subject of artificial respiration: the enthusiastic promoter of the latest method; the white-coated physiologist working under carefully controlled conditions in his laboratory; and the first-aid man suddenly called to respire artificially one of his mates who is clothed in greasy dungarees and is slumped unconscious over a pipe in a dark and awkward corner of the works. The first-aid man, and the situation in which he works in practice, is the member of this trio who merits most consideration. He is professionally conservative and not used to the changing fashions of medical practice. Moreover, he tends to follow the book and puts great weight on the immutable truth of the printed word, but he is the man who has to do the job in the emergency situation.

Some years ago the Holger Nielsen method replaced the Schafer, and now the expired air, or mouth-to-mouth, technique is becoming a rival to the Holger Nielsen. From the physiological point of view, it is clear that the tidal volume of air which can be moved in the subject is greater in the expired air method, and that the Holger Nielsen only produces adequate ventilation in the hands of experienced operators upon subjects with healthy elastic chests.

Should therefore the expired air method now be generally introduced? Physiological opinion is clear, but what of the field worker? The natural revulsion to blowing into the mouth of a dead-looking victim is strong, and this causes a reluctance to be trained. A small hand-bellows can be used as a ventilator. But are these likely to be at hand when the accident happens? Speed in starting is most important, and if the first few minutes are lost, so may be the patient. Nothing deteriorates so quickly as apparatus which is seldom used. An airway can be used to avoid contact of the lips, but it must be inserted with a dexterity and gentleness not always possessed by a man trained as a mechanical fitter or manual worker.

This method of artificial respiration is gaining ground at the present time, and what is needed now is some experience under practical field conditions. Well-reported experience will help to decide whether there should be a general change from the Holger Nielsen to the expired air method of artificial respiration. At the present time this decision should, perhaps, remain open.

(from The Practitioner, October 1961)