The Facts on Hands-Only CPR

Q: What is Hands-Only CPR?

A: Hands-Only CPR is CPR without mouth-to-mouth breaths. It is recommended for use by people who see an adult suddenly collapse in the “out-of-hospital” setting. It consists of two steps:

1. Call 911 (or send someone to do that).
2. Begin providing high-quality chest compressions by pushing hard and fast in the center of the chest with minimal interruptions.

Q: Who should receive Hands-Only CPR?

A: Hands-Only CPR is recommended for use on adults who suddenly collapse. The American Heart Association recommends conventional CPR (that is, CPR with a combination of breaths and compressions) for all infants and children, for adult victims who are found already unconscious and not breathing normally, and for any victims of drowning or collapse due to breathing problems.

Q. Do I need to take a training course to learn how to do Hands-Only CPR?

A. CPR is a psychomotor skill. The AHA continues to recommend that you take a CPR course to practice and learn the skills of CPR, including giving high-quality chest compressions. People who have had CPR training are more likely to give high-quality chest compressions and are more confident about their skills than those who have not been trained (or have not trained in the last five years). Even a very short CPR training program that you can do at home, like the AHA’s 22-minute CPR Anytime™ program, provides skills training and practice that can prepare you to perform high quality chest compressions.

Q. Do I still need to learn "conventional" CPR with mouth-to-mouth breathing?

A. The AHA still recommends that you learn conventional CPR that includes mouth-to-mouth breathing. There are many medical emergencies that cause a person to be unresponsive and to stop breathing normally. In those emergencies, CPR that includes mouth-to-mouth breathing may provide more benefit than Hands-Only CPR. Some examples include:

• Unresponsive infants and children
• Adult victims who are found already unconscious and not breathing normally
• Victims of drowning or collapse due to breathing problems

Q: Is Hands-Only CPR as effective as conventional CPR?

A. Hands-Only CPR performed by a bystander has been shown to be as effective as conventional CPR (CPR that includes breaths) in the first few minutes of an out-of-hospital sudden cardiac arrest. Provision of conventional CPR may be better than Hands-Only CPR for certain victims, though, such as infants and children, adults who are found in cardiac arrest or victims of drowning or collapse due to breathing problems. Any attempt at CPR is better than no attempt.

Q. If I was trained in conventional CPR that includes breathing (30 compressions to 2 breaths, or 30:2 CPR) and I see an adult suddenly collapse, what am I supposed to do?

A. Call 911 and start CPR. 

If you ARE CONFIDENT in your ability to provide CPR that includes breaths with high-quality chest compressions with minimal interruptions, then provide either the conventional CPR that you learned (CPR with a 30:2 compression to ventilation ratio) OR Hands-Only CPR. Continue CPR until an AED arrives and is ready for use or EMS providers take over care of the victim.

If you ARE NOT CONFIDENT in your ability to provide CPR that includes breaths with high-quality chest compressions with minimal interruptions, then provide Hands-Only CPR. Continue Hands-Only CPR until an AED arrives and is ready for use or EMS providers take over care of the victim.

Q. Why don't adults who suddenly collapse need mouth-to-mouth breathing in the first few minutes after their cardiac arrest?

A. When an adult suddenly collapses with cardiac arrest, their lungs and blood contain enough oxygen to keep vital organs healthy for the first few minutes, as long as someone provides high quality chest compressions with minimal interruption to pump blood to the heart and brain.

Q. Not all people who suddenly collapse are in cardiac arrest. Will CPR seriously hurt them?

A. Adults who suddenly collapse and are not responsive are likely to have sudden cardiac arrest and their chance of survival is nearly zero unless someone takes action immediately. You should call 911 and start giving hard and fast chest compressions in the center of the chest, with minimal interruptions. If sudden cardiac arrest is the cause of the collapse, Hands-Only CPR is an easy, effective way for any bystander to more than double the victim's chance for survival. If an adult has collapsed for reasons other than sudden cardiac arrest, Hands-Only CPR could still help by causing the person to respond (begin to move, breathe normally or speak). If that occurs, Hands-Only CPR can be stopped. Otherwise, chest compressions should continue until EMS providers arrive.

Q. Can you break people's ribs doing CPR?

A. Yes. A 2004 review of scientific literature showed that conventional CPR can cause fractures of ribs and/or the breastbone (sternum) in at least 1/3 of cases. In a related study of people who had received such injuries from CPR, the fractures did not cause any serious internal bleeding and, thus, mortality. On the other hand, the chance of surviving an out-of-hospital cardiac arrest is near zero for a victim who does not immediately receive high quality chest compressions with minimal interruptions, followed by additional therapy within minutes (a defibrillating shock and/or more advanced care from EMS personnel).

Q: Is there a danger in jumping in and giving CPR without being trained?

A. On average, any attempt to provide CPR to a victim is better than no attempt to provide help.

For more information, visit the American Heart Association.

Posted October 2014