Heart Association drops mouth-to-mouth CPR, endorses hands-only

On Nov.15 the American Heart Association broke with first aid practices used since the 1960s, endorsing “hands only” cardio-pulmonary resuscitation – rapid chest compression withoutmouth-to-mouth. .

The new guidelines recognize that recent research has shown no real advantage to conventional mouth-to-mouth CPR in outside-the-hospital cardiac arrest cases. In addition, studies show that bystanders are often reluctant to perform mouth-to-mouth resuscitation on strangers, but are more likely to try rapid chest compression.

Hands only CPR pertains specifically to teens or adults (anyone over the age of 8) who have suddenly collapsed (presumably due to a cardiac arrest) in the out-of-hospital (at home, at work, in a park, etc.) setting. The two key steps to providing Hands-Only CPR are to:

1)  Call 911 (or send someone to do that).
2)  Begin providing high-quality chest compressions by pushing hard and fast in the center of the chest at a rate of about 100 beats per minute.

The most important issue following an arrest is to keep the blood circulating which can be accomplished with chest compressions alone. Chest-compression-only CPR is not appropriate in certain instances, such as when infants or children are found unresponsive or in drowning victims. In these cases, the oxygen supply has most likely been depleted and rescue breathing is essential to supply more oxygen to the victim.

Sudden cardiac arrest is a leading cause of death in the United States. Every day, it claims 900 American lives. Only about 6 percent of victims whose hearts stop outside of a hospital survive.

Studies show that either mouth-to-mouth or hands-only CPR may double the survival rate from cardiac arrest, but bystanders typically step in to provide the potentially life-saving intervention in only about one-third of cases. That hesitation is rooted not only in reluctance to lock lips with a stranger, but by anxiety over how to perform conventional CPR, breathing into the victim twice after every 30 chest compressions.

“Many times people nearby don’t help because they’re afraid that they will hurt the victim and aren’t real confident in what they’re doing,” said Michael Sayre, chairman of the Heart Association committee that rewrote the guidelines.

In fact, effective chest compression can break the victim’s ribs about one-third of the time. That’s a risk well worth taking when the odds of survival without CPR are so slim.

The hands-only change stems from three major studies published last year that showed no advantage in using mouth-to-mouth resuscitation in cardiac cases. The latest research on CPR supports the notion that in the critical minutes before an ambulance or defibrillation device arrives, it is very important to provide uninterrupted, deep chest compressions.

Pressure should be applied to the center of the chest, and compressions have to come in rapid succession – about 100 per minute. One easy way to remember the rhythm is that it is roughly equivalent to the beat of the 1977 Bee Gees’ disco hit “Stayin’ Alive.”

“If you are untrained, just remember to push hard and push fast,” advises Sayre. “Doing something is better than doing nothing.”

The message is: if there is any doubt, provide hands only CPR.

For more information on hands-only CPR, click here. 

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