What is Hands-Only or Compression-Only CPR?

Recently there have been many reports in the various media about changes being made to CPR. We have been asked many questions about it but the most common being "Is it true that CPR no longer includes giving breaths?" We will try to clear up some of the confusion about this issue. The answer...well, no and yes. The short answer is that in a life-threatening situation with an unconscious victim who is not breathing and a responder trained in conventional CPR, The responder should call 911 and start CPR as they have been trained. If the responder is not trained in CPR or does not feel confident in the ability to perform CPR the alternative is the Hands-Only method.

According to the American Heart Association there are many medical emergencies that can cause a person to be unresponsive and to stop breathing normally. In those emergencies, CPR that includes mouth-to-mouth breathing can provide more benefit than Compression Only CPR. The American Red Cross and the American Heart Association recommend conventional CPR (CPR with a combination of breaths and compressions) for:

  • All infants and children up to age 8
  • Adult victims found already unconscious and not breathing normally
  • Any victims who have collapsed due to breathing problems, drowning or drug overdose

In a life-threatening emergency where you find a person who has collapsed and not breathing normally and you haven't been trained or you can't recall how to perform full CPR, the American Red Cross and the American Heart Association recommend calling 9-1-1 or the local emergency number, and giving continuous chest compressions until medical help takes over. If you learned conventional CPR (with mouth-to-mouth breathing), then call 911 and provide CPR as you learned it. Hands-Only (compression only) CPR is easier to perform by those with no training and can make the difference between life and death.

There reason that hands-only CPR has been developed is that, typically, bystander response is very low - particularly in cases where people are not trained - and it is hoped that Compression Only CPR will encourage these bystanders to help. The only wrong action in such a situation is no action. Any attempt at CPR is better than no attempt. When an adult suddenly collapses with cardiac arrest, their lungs and blood contain enough oxygen to keep vital organs healthy for the first few minutes, as long as someone provides high quality chest compressions with minimal interruption to pump blood to the heart and brain. If EMS response time is longer than a few minutes conventional CPR can provide more benefit than Compression Only CPR.

In the recent CPR Guideline updates, there are a few additional changes that have been made for the lay responder. The procedure has been simplified, and "Look, Listen and Feel" has been removed. Performance of these steps can be time consuming. For this reason the 2010 AHA Guidelines for CPR and ECC stress immediate activation of the emergency response system and starting chest compressions for any unresponsive adult victim not breathing normally. The previous order of Airway-Breathing-Circulation (A-B-C) has been changed to C-A-B. Beginning CPR with 30 compressions rather than 2 ventilations leads to a shorter delay to first compression.

The recommended depth of compression for adult victims has increased from a depth of 1 ½ to 2 inches to a depth of at least 2 inches. This will ensure sufficient depth to circulated oxygenated blood to the brain and major organs.

The previous rate of compressions, 100 per minute, has been increased to at least 100 per minute. We recognize that witnessing a person suddenly collapse, or finding an unconscious person, can be a frightning experience. Remember the most important thing in such a situation is to call 9-1-1. If you are trained and feel able to perform conventional CPR, by all means do so. But providing Compression-Only CPR until an AED is available or the paramedics arrive is an acceptable alternative for those who are unwilling, unable, or not trained to perform full CPR.

Doing something will always beat doing nothing in a potential life-threating situation.