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Hands-Only CPR Apr08

Hands-Only CPR

I imagine you have heard of or seen the media splash today on “Hands-only” CPR.   It’s not an April’s Fools Joke.   It stems from a press release by the American Heart Association (AHA) yesterday (Mar 31) that in turn reflects the position of their Emergency Cardiovascular Care (ECC) Committee.   You can read the complete scientific article on this in Circulation at

While this shocks some folks like a runaway defibrillator, if you follow the research trends on CPR it’s not a surprise.  The science for some time has questioned the value of rescue breathing (mouth to mouth/mask) for people who don’t suffer cardiac arrest secondary to hypoxia.  In 2005, the AHA almost took this step, but instead wrote “Laypersons should be encouraged to do compression-only CPR if they are unable or unwilling to provide rescue breaths, although the best method of CPR is still compressions coordinated with ventilations.”   In addition, the AHA Guidelines have recommended compression only CPR for dispatcher-assisted instructions for untrained bystanders.

This new change was supported by evidence published from several recent large studies, which looked at hundreds of incidents of bystander CPR on cardiac arrest victims.  None of the studies demonstrated a negative impact on survival when ventilations were omitted from the bystanders’ actions.

The AHA states that Hands-Only CPR should not be used for infants or children (who tend to have cardiac arrests secondary to hypoxia), for adults whose cardiac arrest is from respiratory causes (like drug overdose or drowning), or for an un-witnessed cardiac arrest (where ventilations may benefit the victim who has not been breathing for several minutes).

Hands-only CPR is designed for a witnessed collapse on an adult when there is immediate access to an EMS system.  The two key points in the training are 1) Call 911 and 2) start compressions (hard, fast, uninterrupted).

The AHA ECC committee isn’t recommending abandoning ventilations and compressions.  They ideally want people prepared to manage all types of cardiac arrests.   The recommendation and press release is accompanied by a “Call to Action”.   The AHA is addressing the low rate of bystander CPR, which may be due to fear of disease from rescue breathing and fear of performing CPR incorrectly.

WMI doesn’t plan to change our CPR curriculum.  We will describe this technique and it's rationale for our students.  Hypoxia is a possible cause of cardiac arrests in the wilderness (drowning, avalanche burial).  As well, wilderness CPR does not have access to 911 and AED’s, and rescue breathing is an important adjunct to chest compressions.   For our context, ventilation and compressions are an important skill.

Tod Schimelpfenig EMT, FAWM

Curriculum Director - WMI of NOLS

  Apr 2008


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