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

Date: March 31, 2008

Summary: Cardiopulmonary resuscitation using chest compressions alone can save the lives of adults who suddenly
collapse when their hearts stop beating. The technique – called hands-only CPR (cardiopulmonary resuscitation) – is
a lifesaving option that can be used by people untrained in or unsure about using CPR.

Journal: Circulation

Journal citation: Circulation 2008 Mar 31 [Epub ahead of print]

Read the original article: http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.107.189380

Why it’s important: Effective bystander CPR provided immediately can double or triple a victim’s survival chances.
Finding a way for people who are untrained in or unsure of how to deliver CPR can increase the likelihood that victims
receive CPR when needed, and within the critical four-to-six-minute time window to prevent brain death.

What’s already known: About 310,000 coronary heart disease deaths occur out-of-hospital or in emergency
departments each year in the United States. Of those deaths, about 166,200 are due to sudden cardiac arrest –
nearly 450 per day. Sudden cardiac death (also called sudden arrest) is death resulting from an abrupt loss of heart
function (cardiac arrest) and the heart starts to beat abnormally. Without immediate, effective CPR from a bystander,
a person’s chance of surviving sudden cardiac arrest decreases 7 percent to 10 percent per minute. Unfortunately, on
average, less than one-third of out-of-hospital cardiac arrest victims receive bystander CPR, which can double or
triple a person’s chance of surviving cardiac arrest. CPR is an important tool in reviving victims because it keeps blood
flowing to the brain and heart and makes it more likely that an electrical shock given by a defibrillator will allow the
heart to resume beating normally.

How this study was done: This is not a study in which doctors and scientists conducted experiments and then came to
conclusions. Instead, a group of experts reviewed the literature on past CPR studies to evaluate whether breathing
into a victim’s mouth to provide oxygen and delivering chest compressions provided equal benefit to chest
compressions alone. In the resulting Guidelines for CPR and ECC from the American Heart Association, the experts
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 compressions coordinated with ventilations (breathing into the
person’s mouth). The Guidelines also recommend compression-only CPR when an untrained person is guided
through the process by an emergency medical services dispatcher on the telephone.”

What was found: The new recommendation for compression-only CPR was supported by evidence published from
three large studies in 2007. Each of these studies evaluated the outcomes in a large number of bystanders
performing CPR on cardiac arrest victims. None of those studies demonstrated a negative impact on survival when
mouth-to-mouth ventilations were not delivered.

The bottom line: Hands-only CPR is acceptable to perform on victims of sudden cardiac arrest. Compressions should
be of high quality with minimal interruptions and can increase a victim’s chance of survival.

This content is reviewed regularly. Last updated 05/30/08.