Evidence Supports AHA Recommendation for Hands-Only CPR
Only one in three people suffering from cardiac arrest get prompt cardiopulmonary resuscitation before the ambulance arrives. Mouth-to-mouth resuscitation is sometimes responsible for the reluctance of would-be saviors to perform CPR. Two new studies published in the New England Journal of Medicine provide additional evidence to what the American Heart Association has been saying for two years – chest compressions alone are as effective in rescuing victims of heart attacks as conventional CPR.
Chest compressions work by circulating oxygen that is already present in the blood. The bloodstream of a person breathing normally -- up until a cardiac arrest -- contains enough oxygen to sustain life for several minutes, until an ambulance can arrive with oxygen supplementation.
The two new studies were similar in design. The first, conducted by Dr. Thomas D. Rea of the University of Washington in Seattle and his colleagues, included 1,941 heart attack victims. In the second, conducted by Dr. Marten Rosenqvist of the Karolinska Institutet of Stockholm, 1,276 victims were studied.
911 operators randomly instructed callers to administer either conventional CPR or “hands-only” CPR. Rea and his colleagues found that 12.5% of those given only compressions survived to be discharged from the hospital, compared to 11% of those given conventional CPR. Rosenqvist and colleagues found that the 30-day survival was 8.7% for those given compressions only, compared to 7% for those given conventional CPR.
While the differences appear small, removing the element of hesitation of a bystander to perform CPR because it is now unnecessary to provide rescue breathing may increase the number of patients actually receiving the life-saving technique. The AHA notes that about 60% of cardiac arrests are witnessed by someone, and most occur at home.
"These studies reinforce the message that the American Heart Association has been promoting since 2008," said Dr. Michael Sayre, a professor of emergency medicine at Ohio State University in Columbus and a spokesman for the AHA. "When you encounter a person who has collapsed suddenly, the best thing to do is to call 911 and then push hard and fast on their chest. It's simple, and something anyone can do even if they don't have any training.”
Some communities who have been implementing “hands-only” CPR have seen a dramatic increase in survival rates. In Dallas TX, survival rates have increased by 60%. In some smaller areas outside of Dallas, where the new guidelines could be implemented more quickly, the survival rates have quadrupled, according to Dr. Paul E. Pepe, head of the emergency medicine department of the University of Texas Southwestern Medical School.
The “rescue breathing” part of CPR would still be necessary for infants and children, choking victims, those who have suffered drowning, or people who have respiratory problems.
Rea TD, et al "CPR with chest compression alone or with rescue breathing" N Engl J Med2010; 363: 423-433.
Svensson L, et al "Compression-only CPR or standard CPR in out-of-hospital cardiac arrest" N Engl J Med 2010; 363: 434-442.
Weisfeldt ML "In CPR, less may be better" N Engl J Med 2010; 363: 418-483.