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Exchange Breathing Method

A first aid seizure rescue method

The Exchange Breathing Method (EBM) is a technique which can be used as a first aid seizure rescue method.  This means that it can be used to try and stop a seizure which is in progress.

The basics

Whilst someone is having a seizure (or during the aura pre-seizure stage), a caregiver or first aider can give a rescue breath of their air into the other person’s nose (similar to CPR but using the patient’s nose).

Always follow the full instructions, learn CPR resuscitation, and seek permission and reassurance of a relevant healthcare professional prior to using the Exchange Breathing Method.

Medical research and promotion of EBM

Some relevant references to papers regarding elements of this method are given below. However, more research needs to take place into pinpointing the exact mechanism of the method.

Promoting the method to as wide an audience as possible, is also an important step, with the ideal that the Exchange Breathing Method becomes the number one go-to first aid to try for anyone having a seizure.

To aid this process of research and promotion, a charity is seeking to raise funds for all of this.  Full details of the research and promotion project are here

If you use EBM, please let your healthcare professional know, as this will also help to spread the word, and help more people to find out about this invaluable technique.

Full instructions

These are given below and there is a helpful instructional video that will take you through.

Background to the Exchange Breathing Method

My name is Gemma Herbertson, and I am the Founder of Neuro Frontiers.  After around 3 years of my son having 100-500+ seizures a week, I was desperate for answers.  I began an intense period of research, reading thousands of papers.  I also formed an online group of people looking for similar answers (it is called Diets for Epilepsy www.facebook.com/groups/DietsForEpilepsy).  Some incredible people in the group kindly shared what they knew as well. One person in particular who researched and shared some very pertinent information was Bernhard Rohrbeck.  When I connected the group’s thoughts (particularly Bernhard’s) with my research, I had one of those Eureka! moments, and realised that first of all, we have a natural and free source of something called Carbogen contained in every out-breath we make.  I also realised that (because of some potential nasal receptors, and what they might trigger in the brain) that to breathe an out-breath up the nose of someone having a seizure could well be the answer.

Very bravely, and nervously, one day I tried this on my son…I did it very similarly to the breath of life given in CPR but just up the nose, and I was astonished to find that his seizure stopped!  As he was having so many seizures, I got to practice a lot, and found it worked all the time!  Sometimes they stopped after 30-40 seconds, other times his seizures would stop almost immediately!

Over time, I found my son’s seizures became milder and milder, and his recovery (sleep time) was often shorter, or he may not need a sleep at all.  His seizures ceased completely in May 2017 (after 8 years of having them).  EBM was just one tactic we used to help them to stop.

In the earlier days, I shared my experiences online, and was thrilled when others started to try the method, and found it worked for them too.  I was especially pleased that it worked on so many different types of seizures.

I encourage people who use EBM to discuss it with their medical professional.  This has been really useful, as the response is generally reassuring, with most saying that it is unlikely to do any harm, so yes, go ahead and try it.

I set up a separate online group (www.facebook.com/groups/EBMFirstAid) for people using the method to exchange questions and experiences; and more recently have set up a charity with two other parents, called Answers & Hope, which is fundraising for research into the Exchange Breathing Method.

My experiences of EBM with my son

My son was the first person I used the EBM with.  I found I could quickly stop a seizure, and his recovery (sleep) time was less or none.  Sometimes a seizure would appear, but it would seem milder than usual.

My son had myoclonic seizures in clusters, preceded by an aura. When he was a baby I did not know this was an aura. He spent most of the first three months of his life in hospital whilst the doctors tried to work out what was wrong with him. A SATS monitor measures the percentage of oxygen in the blood stream (normally around 96-99%).  During this time, the ‘aura stage’ of a seizure was when the SATS monitor started to go down, and I could clearly see his breathing pattern start to go strange on the machine. After a few weeks in hospital, I started to hit the emergency button before the monitor even beeped because I knew what his breathing pattern meant. None of the doctors or nurses understood what this pattern meant, and were astonished that I ‘knew’ a seizure was coming. After four years and a lot of research, I began to get a much better understanding.

With my son, within seconds of starting his aura, his lips would turn fawn to grey to blue. He would be quiet and look pensive. I could feel his ribs, and he would still bel breathing, but fast, and erratic – mainly with his upper chest/thoracic area (not with his abdomen/diaphragm). He was clearly hyperventilating (EXACTLY what doctors ask adults to do when they are undergoing an EEG test to induce a seizure).  The hyperventilation meant there was not enough CO2 (carbon dioxide) in my son’s blood – because his breathing was too fast, too shallow, and using the upper chest.  If he were an adult I might get him to breathe in a paper bag – just like you would with someone having a panic attack. However, he can’t understand this and a bag would frighten him more.  Eventually, his breathing would stop for prolonged periods, and by this point he would clearly be having a seizure.  To halt this sequence of events, I would do Exchange Breathing to get some CO2 back into his system, to normalise his breathing, and this seemed to then halt his seizure.

My son previously had strong and frequent seizures.  Before I learned the EBM, from the point of his aura with blue lips stage, my son would normally progress to having a series of seizures (from 19 to 50) and then sleep for at least 2 hours.  If I missed the start of the aura stage, my son might go on to have some seizures, but most times these were milder (maybe just eye flickers, rather than a fully physical myoclonic jerk), less (maybe just 4 to 6 in a cluster), and the recovery time was quicker.

For me, as a parent and caregiver, learning the EBM has been life-changing.  The only stress is being on high alert (day and night) to spot a seizure coming, and administer the CO2 from my out-breath as soon as possible.

When I told my son’s consultants about “Exchange Breathing” with my son and stopping his seizures. The first passed virtually no comment. The second, his paediatric neurologist, said he was aware of such a phenomena with CO2 mainly because he was doing some “very promising” research on something called ‘carbogen’(a mixture of carbon dioxide and oxygen)!  It was certainly a relief that they were not objecting to the use of the method.

Disclaimer

The very first, most important thing to note is that I am NOT a medical professional.  I am simply explaining my experience.  If you want to try any of the actions mentioned here, please check them with a relevant medical professional first (feel free to print off the instructions and the research and results from the studies mentioned below to show them).

Instructions for caregivers

These are the instructions I use with my son.

  1. Implement the EBM as soon as you see someone having a seizure, it seems to work especially well at the aura stage (if someone has auras).
  2. Put your mouth over the nose of the person having a seizure.  Very gently breathe into their nose: just as you might in an emergency resuscitation (CPR) procedure. (NB the younger a child or baby is, the gentler you may need to deliver the breath, to protect their lungs.  Undertaking a course in CPR is highly recommended to learn the pressure necessary for different age groups).
  3. Tilting the head does not appear necessary – the CO2 contained in your breath just needs to reach as far as the olfactory receptors at the top of the nasal cavity inside the nose.  However, tilting the head gently back (again only after training in CPR) may work better for some people – though this can be difficult whilst a person is having a seizure.
  4. EBM can be used in any position:  it can be done whilst the person is lying on their back or side, standing or sitting.
  5. If the person is still breathing, try to time your ‘out breath’ with their ‘in breath’.  You may like to watch the chest rise and fall or feel their ribs moving in and out.  If they are not breathing at all,  just give one gentle ‘puff’ of your out-breath into their nose.  You should find that the person almost immediately takes an in-breath (sometimes sounding like someone who has been holding their breath underwater, and who has just come up to the surface and breathed in).
  6. Sometimes, just one breath of your CO2-ladened out-breath is sufficient to re-start and re-regulate the person’s breathing.  Occasionally, two or three more breaths from you into their nose are necessary.  You can leave about five seconds between giving each separate breath.
  7. Once the person has started breathing normally again, they may have a little sigh, and then go back to what they were doing before. Or they may need to recover with a rest or sleep – often for less time than previously.

The use of the EBM is an emergency measure: a seizure first aid method: i.e. it does not stop the seizure from coming in the first place.

Limitations with Exchange Breathing

There are some circumstances in which it can be more difficult to administer a breath in the EBM method.  Those are recognised here:

  • If the person struggles or moves away from you
  • In the car (or anywhere else difficult to spot a seizure occurring or where it’s hard to administer Exchange Breathing)
  • If the care-giver is hyperventilating, then there may be reduced amounts of CO2 in their out-breath.  In this case, the caregiver should focus on staying calm, taking a  couple of deep breaths in, and holding it in to let the CO2 in their lungs build up.  I do know that when you use the EBM for the first time, it can be hard to stay calm, but as you will now realise, this part is crucial to allow you to breath out air with sufficient levels of CO2.

How does the Exchange Breathing Method work and why the nose?

Breathing into the nose seems to be of great importance.

When I first found out about hyperventilation causing seizures (as is used in an EEG session), and CO2 being the trigger to stop them(the decades old ‘paper bag method’), I tried all sorts of techniques to get CO2 into my son, including breathing my own breath into his mouth, and breathing my breath into a bag and then literally squeezing the bag out at his face.  There was some success with these methods, but it was haphazard.  So I continued to research, and came across olfactory neurons- which are one theory as to how the EMB works.

Up inside your nose, at the top of the nasal cavity, you have a group of nerves called the Olfactory Nerve.  There are actually lots of tiny nerves in this area.  Each of them has a ‘chemo-receptor’ function.  This means that they detect chemicals.  Most obviously, they detect smells.  However, they also detect levels of CO2 in the air (see http://www.ncbi.nlm.nih.gov/pubmed/20696215 and https://www.ncbi.nlm.nih.gov/pubmed/2536251) .

The olfactory nerves in the nasal cavity lead to the hypothalamus region of the brain.  This is responsible for the autonomous processes in your body (automatic functions we do not need to give conscious thought to e.g. breathing, blood pressure, heart rate, digestion, sweating, etc); and it is responsible for maintaining homeostasis in the body.  In general terms this is keeping things on an even keel, and maintaining things such as body temperature and the mix of gases in the bloodstream, at an optimal level so that your body functions efficiently.  You can think of homeostasis as wanting to return the body to a ‘set point’ in each of the areas (like a thermostat in terms of heating – telling the body to warm up when it gets too cold, and to cool down when it gets too warm).

The hypothalamus is a part of the limbic region of your brain.

The olfactory nerve conveys information on CO2 levels to the hypothalamus.  When someone has hyperventilated, the body actually thinks there is enough oxygen (O2) in the system, and therefore there is no trigger for the body to take another breath.  The trigger for taking a breath is in the CO2 which is breathed out of the body.  If no CO2 is coming out of the lungs, then there is no trigger.  However, by exposing the olfactory nerve to some CO2 from elsewhere (i.e. the CO2 which is in the breath of someone else breathing into the nose), then the hypothalamus receives that signal and breathing resumes, and thus a seizure should stop.

It might be relevant to note that humans are designed to be nose breathers (and this may be why mouth breathing e.g. during snoring whilst asleep, can lead to a seizure for some people).

Another theory of why it works relates to the work of Dr Justin Fenstein of the University of Iowa (currently at Laureate Institute for Brain Research, Tulsa Oklahoma), who discovered that CO2 inhaled at high enough levels triggers a panic.  Being startled in this way will generally result in a sharp intake of breath.  A group of chemoreceptors located in the brain stem (in the rostral pons and the caudal pons) monitor CO2 in the bloodstream, and modulate the rate of breathing (faster or slower) accordingly.  Yale physiologist, Yandell Henderson, used a carbogen mixture (5% carbon dioxide and 95% oxygen) to treat pneumonia, asthma, strokes, and even asphyxia in newborn babies.  Between the 1900’s to the 1950’s other blends of carbogen (up to 30% carbon dioxide) were used as treatments for conditions such as epilepsy.  However, research into and use of this stopped around the 1950s.