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Part of the advocacies of the CPR Council is the campaign for hands-only CPR for lay bystanders. This is an effort to reduce barriers to the performance of CPR by a bystander during an out of hospital cardiac arrest.

Conventionally, based on the 2005 basic life support guidelines, the basic CPR consists of repetitive cycles of chest compression and ventilation in a 30:2 ratio. The said guidelines also give great emphasis to performance of high quality chest compressions with minimal interruptions.

Several studies have suggested that trained rescuers doing the traditional 1-person CPR (consisting of the usual chest compression and mouth to mouth ventilation) take much longer to initiate CPR than those trained to perform hands-only CPR. Hence, hands-only (compression-only) CPR by a bystander may result in a faster time to initiation of CPR and lead to delivery of a greater number of chest compressions with fewer interruptions for the first several minutes after cardiac arrest.

In 2008, the American Heart Association Emergency Cardiovascular Care Committee issued a science advisory with a call to action for bystander response during out of hospital cardiac arrest (Sayre et al, Circulation 2008; 117:1-6). This was based on a body of scientific data from animal and human clinical studies as well as the committee’s drive to reduce barriers to and increase rates of bystander CPR.

The Committee recommended that all victims of cardiac arrest receive, at least, high-quality chest compressions with minimal interruptions. In the event that an adult suddenly collapses, trained or untrained bystanders should—at a minimum—activate their community emergency medical system and provide high-quality chest compressions, minimizing interruptions. This was a Class I recommendation.

If however, a bystander was not trained in CPR, then he or she should do hands-only CPR and continue this until an automated external defibrillator arrives and is ready for use or until medical assistance is available to take over care of the victim. This was given a Class IIa recommendation.

If he or she was previously trained in CPR and is confident in giving rescue breaths with minimal interruptions in chest compressions, then he or she should provide either conventional CPR using a 30:2 compression-to-ventilation ratio as recommended in the 2005 guidelines or do hands-only CPR, and should continue CPR until medical assistance is available or until the defibrillator arrives. This was a Class IIa recommendation.

Finally, if the bystander was previously trained in CPR but is not confident in his or her ability to provide conventional CPR including high-quality chest compressions, then he or she should give hands-only CPR – a Class IIa recommendation.

The Committee nevertheless encouraged the public to obtain a comprehensive training in CPR to learn the basic skills needed in the management of cardiovascular emergencies. In addition, it acknowledged that some cardiac arrest victims such as pediatric victims, victims of drowning, trauma, airway obstruction, acute respiratory diseases, and apnea may benefit from the conventional CPR technique.

The recommendations were based on a body of scientific data demonstrating that chest compression only was as good as chest compression and ventilation for out of hospital cardiac arrests. Key human clinical studies have demonstrated that there was no significant survival difference between victims of out of hospital cardiac arrest given the chest compression only CPR and those given the traditional compression-ventilation CPR. Survival and neurologic outcome after bystander chest compressions only CPR did not differ from the conventional bystander CPR for adult patients with witnessed out-of-hospital cardiac arrests.

The basis for chest compressions only CPR is the assumption that at the time of a sudden cardiac arrest or collapse, the adult victim would have probably been breathing normally and that his or her lungs and blood would still have a fresh supply of oxygen that can last for at least a few minutes even if breathing stops. Furthermore, the oxygen requirement of a person in cardiac arrest is low during the first few minutes after collapse.

It is expected that hands only CPR will simplify training for most lay responders, decrease bystander reluctance to perform CPR, and broaden the reach of CPR training. Hopefully, this will decrease the time to initiation of CPR in cardiac arrests outside the hospital, result in the delivery of greater number of chest compressions with fewer interruptions, and ultimately improve cardiac arrest survival rates.

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