News Review From Harvard Medical School -- Study: 'Hands-Only' CPR May Be Better
"Hands-only" CPR saves more lives than the traditional kind that includes mouth-to-mouth breathing, a new study finds. In 2008, the American Heart Association said that people giving CPR should stick with doing firm, rapid pushes on the chest. It said "rescue breaths" were not necessary. The hope was that this would get more people to do CPR. Early research also showed it was effective. The new study included 1,300 people who had a cardiac arrest outside of a hospital. In each case, someone saw the person collapse. Bystanders gave shocks from an automated defibrillator and also did CPR. Of those who got hands-only CPR, 46% were alive a month after their cardiac arrest. About 40% of those who got traditional CPR with rescue breaths were alive. More people kept good brain function with hands-only CPR -- about 40%, compared with 33% of those who got rescue breaths. The journal Circulation published the study. HealthDay News wrote about it December 10.
By Howard LeWine, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
Without warning, a person next to you collapses, twitches and gasps a few times, then lies deathly still. Cardiac arrest! Almost everyone knows to call 911. But what next?
This is where most of us freeze while waiting for the ambulance. Why? Even those who have taken CPR classes usually can't recall right away exactly what to do at that moment. In addition, there is the fear of doing it wrong. Many people also are uncomfortable putting their mouths on a stranger's mouth.
The American Heart Association (AHA) recognized that unless CPR could be made a lot simpler, most people wouldn't do it. In 2008, the AHA decided to recommend "hands-only" CPR for everyone except people who are trained and comfortable with providing standard CPR. Hands-only CPR means you do only chest compressions, without breathing into the mouth.
The new AHA recommendation made sense. There's no question that the body needs a constant supply of oxygen. That's why earlier CPR guidelines called for 2 breaths for every 15 chest compressions. But setting up to do this leads to a loss of valuable seconds. It requires getting the head in the right position and then clearing the mouth. Doing all this correctly is a challenge for anyone.
Most victims of a sudden cardiac arrest already have a fair amount of oxygen in their lungs and bloodstreams. The people aren't moving, so they aren't using much oxygen. That means it takes a few minutes for their bodies to use up that stored oxygen. Meanwhile, a little bit of air is passively pushed out and pulled in with every chest compression a rescuer performs.
But is hands-only CPR at least as effective as the old CPR? The results of this study suggest that hands-only is even better at reviving a person from cardiac arrest. In fact if there is a defibrillator (an electrical heart shocker) close by, potentially 1 in 2 deaths could be prevented. Now saving 1 out of 5 people in the field is considered highly successful.
What Changes Can I Make Now?
If you witness a cardiac rest:
- Call 911, or have someone else do it.
- Place both of your hands, one on top of the other, over the middle of the person's chest.
- Press down hard enough to make the chest move inward about 1½ to 2 inches.
- Relax to let the chest rebound.
- Repeat this press-and-relax motion quickly, almost twice a second if you can. (Try keeping time to the old Bee Gees song "Stayin' Alive.")
- Don't stop if the person seems to gasp or move! Keep pushing until help arrives.
In an emergency, it's hard to think straight. Take a CPR course. And watch this video on CPR once in a while. It will help you remember what to do should the need arise.
What Can I Expect Looking to the Future?
The new message: CPR is simple. All you really need to know: Put your hands on the middle of the person's chest, push hard and relax. Repeat the push-relax cycle twice a second. Don't stop.
And don't worry about doing it wrong. Any CPR is better than no CPR.