When it comes to saving the life of someone whose heart
has suddenly stopped, it may be best for bystanders to keep it simple and use
The American Heart Association is issuing a "call to action" for
bystanders who are not trained in conventional CPR to use only their hands,
without the rescue breathing, in the crucial moments after they witness an
out-of-hospital sudden cardiac arrest, when the heart stops beating.
CPR stands for cardiopulmonary resuscitation. It's intended to keep blood
moving in people whose hearts have stopped and help keep someone alive until an
emergency medical team arrives.
Conventional CPR includes two parts. One part is mouth-to-mouth
resuscitation, also known as the "breath of life." The second part is
chest compressions, when you push down hard and fast on a person's chest, more
than once a second, pressing down at least an inch and a half before
"Many times people nearby don't help because they're afraid that they
will hurt the victim and aren't confident in what they're doing," says
Michael Sayre, MD, chairman of the AHA's statement writing committee. Sayre is
associate professor in the Ohio State University department of emergency
medicine in Columbus.
Sayre says that by using what is called hands-only CPR, or chest
compressions, "bystanders can still act to improve the odds of survival,
whether they are trained in conventional CPR or not."
According to the AHA, more than 300,000 U.S. adults die annually from sudden
cardiac arrest outside the hospital.
The AHA's 2005 recommendations urged bystanders to use compression-only CPR
only if they were unable or unwilling to give rescue breaths. This update
follows recent studies and the consensus of the AHA's Emergency Cardiovascular
These are the recommendations: If you are witness to a sudden collapse of an
adult, call 911 and start chest compressions hard and fast in the middle of the
If the bystander isn't trained in CPR or is not confident in being able to
do rescue breaths, then they should only do hands-only CPR until emergency
medical assistance arrives or an automated external defibrillator (AED) is
available for use.
If the bystander was trained in CPR and is confident in being able to
provide rescue breaths with minimal interruptions to chest compressions, then
they should give CPR with a 30:2 ratio of chest compressions to breaths or
hands-only CPR and continue until an AED is available or emergency medical
providers arrive to help.
Newer studies have found that in people with out-of-hospital cardiac arrest,
survival numbers were comparable between those who received chest-compression
only CPR and conventional CPR.
The researchers also note it could take longer for someone trained in
traditional CPR to get it going and that people giving chest compressions alone
get to it faster with fewer interruptions.
Research shows that while bystander CPR can more than double a person's
chances of surviving cardiac arrest, in most cities it is performed in only
about 27% to 33% percent of the cases. Chest compression-only CPR may help
lower bystander reluctance to perform CPR.
The AHA is also recommending changes in the way CPR is taught, streamlining
the technique by focusing more on how important chest compressions can be in
keeping someone alive until they can get to a hospital.
Some 94% of sudden cardiac arrest victims die before reaching the hospital,
according to the AHA. On average, only 24% of cardiac arrests that occur
outside of a hospital have had a bystander perform CPR.
How can you tell if someone's heart has stopped beating? According to the
AHA, it's when the person collapses, does not respond to gentle shaking, stops
breathing after two rescue breaths, and is still not breathing, coughing , or moving.
If you do give someone CPR, remember o call for help -- 911 -- immediately
as it's intended only as a short-term measure until emergency medical help
The hands-only CPR technique is only for adults whom you have seen collapse
outside the hospital. Hands-only CPR is not to be used for children or infants
or an adult whose heart has stopped because of non-cardiac causes such as a
drug overdose or near drowning. In those cases, the AHA says conventional CPR
with breaths is still the best technique to perform. The AHA still encourages
people to learn conventional CPR at which time they will also learn how to do
That statement and new recommendations are published in the April 29 edition
By Kelley Colihan
Reviewed by Louise Chang
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