'Hands-Only' CPR May Work Best for Cardiac Arrest 10/05/10
TUESDAY, Oct. 5 (HealthDay News) -- Among adults whose heart had
stopped beating, those who received 'hands-only' cardiopulmonary
resuscitation (CPR) from a bystander were 60 percent more likely to
survive than those who received no CPR or conventional CPR with
This is good news, researchers said, because not only is
'hands-only' CPR -- in which the rescuer does rapid, uninterrupted
chest compressions -- easier for the public to learn and remember,
research shows bystanders are more likely to act when they don't
have to do mouth-to-mouth.
"Anyone can do 'hands-only' CPR and anyone can save a life," contends lead study author Dr. Bentley J. Bobrow, medical director of the Arizona Department of Health Services' Bureau of Emergency Medical Services and Trauma.
"You don't have to have a special certification or take a special course," said Bobrow, who is also an emergency physician at Maricopa Medical Center in Phoenix.
Researchers stressed the findings apply only to adults given CPR
by the lay public. Children should still usually receive rescue
breathing, Bobrow said, as well as anyone who was choking, drowning
or having breathing trouble before becoming unconscious.
The study is published in the Oct. 6 issue of the
Journal of the American Medical Association.
In 2005, Bobrow and his colleagues launched a statewide
initiative in Arizona to improve rates of cardiac arrest survival,
including a performance improvement program for emergency medical
services and increasing rates of bystander CPR. With the help of
fire departments, the initiative included training throughout the
community, in schools, online and a mass media campaign.
From 2005 through 2009, 4,415 adults experienced out-of-hospital
cardiac arrest in Arizona and were not treated by a medical
professional. Of those, 2,900 received no CPR from witnesses, 666
(about 15 percent) received conventional CPR that includes rescue
breathing and 849 (about 19 percent) received compression-only
About 13.3 percent of those who received compression-only CPR
survived and were discharged from the hospital compared to only 7.8
percent of those who received conventional CPR, a 60 percent
difference. Those who received no bystander CPR at all fared the
worst -- only 5.2 percent lived.
Over time, along with public education campaigns encouraging
'hands-only' CPR, the annual rate for bystanders attempting CPR
improved from about 28 percent in 2005 to nearly 40 percent in
2009. That rise coincided with the shift to the compression-only
technique -- in 2005, only about 20 percent of lay rescuers did
compression-only compared to nearly 76 percent in 2009.
Overall survival increased from about 3.7 percent in 2005 to 9.8
percent in 2009, the study authors reported.
About 300,000 Americans per year experience cardiac arrest, in
which the heart stops beating, outside of hospital settings.
Without CPR to continue to pump blood and oxygen to the brain,
death occurs within minutes, Bobrow said.
Without a bystander to step in and start compressions, emergency
responders often arrive too late, Bobrow said. And the longer a
victim goes without oxygen, the less likely an automated external
defibrillator will work to restart the heart rhythm.
But for a variety of reasons, bystanders often fail to act. Some
are unsure what to do, afraid of doing CPR wrong or don't want to
do mouth-to-mouth breathing. "What we have tried to do with
'hands-only' CPR is take out all the reasons people don't act when
they see a cardiac emergency -- fear, panic, indecision, confusion
-- out of the equation," Bobrow said. "There is no reason not to
try to do hands-only CPR."
That's a crucial message, said Dr. Michael Sayre, an American
Heart Association spokesman and associate professor of emergency
medicine at Ohio State University. The American Heart Association
began recommending 'hands-only' CPR in March 2008.
"That Dr. Bobrow and colleagues could increase rates of bystander CPR through a public education campaign and making the instructions simpler is very encouraging," Sayre said. "In the past, people felt they couldn't intervene because they hadn't taken a class or were confused about what to do . . . We're hopeful that bystander CPR will become more common with simpler instructions. The Arizona study shows this is likely to happen."
Yet more research needs to be done before it can be said
definitively that compression-only CPR works better than CPR with
mouth-to-mouth, when done correctly, Sayre said.
Two studies in the July 29 issue of the
New England Journal of Medicine also found that when
bystanders were instructed by emergency dispatchers to give either
standard CPR or chest-compression-only CPR, survival rates were
similar between the two techniques.
Why might compression-only CPR work better than conventional CPR
When doing mouth-to-mouth, the rescuer has to stop compressions,
which can lead to a rapid loss of life-sustaining blood flow to the
brain, Bobrow said. Also, rescuers may have a tendency to blow too
much air into the lungs. Overinflating the lungs can make
compressions less effective when they resume, Bobrow said.
Learn more about hands-only CPR from the
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