Hands only CPR effective: New guidelines

By Dr. Ananya Mandal, MDOct 17 2010

According to latest changes made to CPR guidelines rescuers need to start with hard, fast chest presses before giving mouth-to-mouth. The change is termed as “the simplest step first” for traditional CPR, said Dr Michael Sayre, an emergency doctor at Ohio State University Medical Centre and co-author of the guidelines issued by the American Heart Association.

The change in the guidelines comes from the recent evidence that hands only CPR does benefit individuals with heart attack. In 2008, the heart group said untrained bystanders or those unwilling to do rescue breaths could do hands-only CPR until paramedics arrive or a defibrillator is used to restore a normal heart beat. Now it is seen that everyone from professionals to bystanders who use standard CPR should begin with chest compressions instead of opening the victim's airway and breathing into their mouth first.

This is a deviation from the old ABC training: airway - breathing - compressions. That called for rescuers to give two breaths first, then alternate with 30 presses. According to Dr Sayre ABC approach took time and delayed chest presses, which keep the blood circulating. “When the rescuer pushes hard and fast on the victim's chest, they're really acting like an artificial heart. That blood carries oxygen that helps keep the organs alive till help arrives,” he explained. “Put one hand on top of the other and push really hard,” he said.

The situations where this can benefit include sudden cardiac arrest, when the heart suddenly stops beating. This can occur after a heart attack or as a result of electrocution or near-drowning. The person collapses, stops breathing normally and is unresponsive. The change applies to adults and children, but not newborns.

One of the critics of the guidelines includes Dr Gordon Ewy of the University of Arizona Sarver Heart Centre training for both hands only and mouth to mouth should be provided. He said the guidelines could note the cases where breaths should still be given, like near-drownings and drug overdoses, when breathing problems likely led to the cardiac arrest.

According to Dr Ahamed Idris, of the University of Texas Southwestern in Dallas the pressure of the compressions is often a grey area for most people. They may be scared that they are pressing too hard. “We want to make sure people understand they're not going to hurt the person they're doing CPR on by pressing as hard as they can,” he said. “The best chance was to start chest compressions in the house, immediately,” he said.

The findings appeared in the Oct. 14 online edition of The Lancet. For the study the team analyzed data from three randomized trials involving more than 3,000 patients who received CPR from bystanders guided by emergency dispatchers. The survival rate was 14 percent for those who received chest-compression-only CPR and 12 percent for those who received standard CPR. This means that the relative chances of survival increased 22 percent with chest-compression-only CPR. The absolute increase in survival was 2.4 percent, which means that one life would be saved for every 41 patients who received chest-compression-only CPR.

In September a team from the University of Michigan reported that patients who experience sudden cardiac arrest outside of a hospital setting fare just as well when treated with chest compressions before being treated with an electrical defibrillator as they do when getting immediate defibrillation. That study appeared in the journal BMC Medicine.

In July there were two studies published in the New England Journal of Medicine each found that chest compression alone was equal to compressions plus mouth-to-mouth when it came to helping people experiencing a heart attack.