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Hands-Only CPR, New Recommendation for Cardiac Arrest Cases from the American Heart Association

Thu April 03 2008 12:40 pm
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Hands-Only CPR is a new, potentially lifesaving technique to help adults who suddenly collapse due to cardiac arrest. Anyone can do hands-only CPR, and every bystander should perform Hand-Only CPR now that is simplified and avoids mouth-to-mouth breathing.

When an adult has sudden cardiac arrest, survival depends greatly on immediately getting CPR from someone nearby. Less than 1/3 of those people who experience a cardiac arrest at home, work or in a public location get that help. Many bystanders have been concerned about doing mouth-to-mouth breathing, especially to a stranger. Many people even refuse to take instructions from 9-1-1 operators that tell bystander/callers how to do CPR over the phone while waiting for paramedics to arrive at the scene. In a study of 168 rescue calls eligible for pre-arrival CPR instructions, only 25 victims received chest compressions from bystander/callers. Most callers were unwilling or emotionally upset in their inability to follow instructions. Reasons often cited for the reluctance to perform CPR often
include concerns about disease transmission related to performing mouth-to-mouth ventilation. It might seem selfish to avoid being grossed out about being dreawn into performing mouth-to-mouth breathing, but now it doesn’t matter because the American Heart Association is recommending Hands-Only CPR for adult victims of sudden collapse and cardiac arrest.

Studies of real emergencies that have occurred in homes, at work or in public locations, show that  two steps — (1) calling 9-1-1 and (2) pushing hard and fast on the center of the victim’s chest — called Hands-Only CPR, can be as effective as conventional CPR. It might even be more effective. Providing Hands-Only CPR to an adult who has collapsed from a sudden cardiac arrest can more than double that person’s chance of survival. It is important to note that if no shock from a defibrillator or automated external defibrillator (AED) is delivered in the first four minutes of a deadly heart rhythm, the heart stops altogether and it becomes much harder to get it restarted. Nevertheless CPR helps the chances of a restart.

While all victims of collapse benefit from chest compressions, the new call to action for hands-only CPR does not specifically apply to cardiac arrest in children, cardiac arrest presumed to be of non-cardiac origin, victims of drowning and trauma, victims of air obstruction, victims of respiratory diseases, and victims of apnea (such as from drug or alcohol overdose). In other words chest compressions are better than nothing, but rescue breathing is more important for these cases.

Here are the recommendations for the new call to action:

All victims of cardiac arrest should receive, at a minimum,
high-quality chest compressions (ie, chest compressions of
adequate rate and depth with minimal interruptions). To
support that goal and save more lives, the AHA ECC
Committee recommends the following.

When an adult suddenly collapses, trained or untrained
bystanders should—at a minimum—activate their community
emergency medical response system (eg, call 911) and
provide high-quality chest compressions by pushing hard and
fast in the center of the chest, minimizing interruptions (Class I).

If a bystander is not trained in CPR, then the bystander
should provide hands-only CPR (Class IIa). The rescuer
should continue hands-only CPR until an automated external
defibrillator arrives and is ready for use or EMS
providers take over care of the victim.

If a bystander was previously trained in CPR and is
confident in his or her ability to provide rescue breaths
with minimal interruptions in chest compressions, then the
bystander should provide either conventional CPR using a
30:2 compression-to-ventilation ratio (Class IIa) or handsonly
CPR (Class IIa). The rescuer should continue CPR
until an automated external defibrillator arrives and is
ready for use or EMS providers take over care of the

If the bystander was previously trained in CPR but is not
confident in his or her ability to provide conventional CPR
including high-quality chest compressions (ie, compressions
of adequate rate and depth with minimal interruptions)
with rescue breaths, then the bystander should give
hands-only CPR (Class IIa). The rescuer should continue
hands-only CPR until an automated external defibrillator
arrives and is ready for use or EMS providers take over the
care of the victim.

Interestingly, medical professionals are being advised of a new CPR method that starts with a round of 200 chest compressions before applying a defibrillator shock since last March, 2008. Rescue teams in Arizona used the news method on people with cardiac arrest outside of a hospital setting with survival rate triple of the standard method.

See also …
American Heart Association —
Circulation —

Lerner EB, Sayre MR, Brice JH, White LJ, Santin AJ, Billittier AJ 4th, Cloud SD. Cardiac arrest patients rarely receive chest compressions before ambulance arrival despite the availability of pre-arrival CPR instructions. Resuscitation. 2008 Apr;77(1):51-6. Epub 2007 Dec 26.

Michael R. Sayre, Robert A. Berg, Diana M. Cave, Richard L. Page, Jerald Potts and Roger D. White. Hands-Only (Compression-Only) Cardiopulmonary Resuscitation: A Call to Action for Bystander Response to Adults Who Experience Out-of-Hospital Sudden Cardiac Arrest. A Science Advisory for the Public From the American Heart Association Emergency Cardiovascular Care Committee.

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