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1-MINUTE CLINICALS: Circulation vs. Breathing: Hands-Only CPR


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October 7, 2010 - Cardiopulmonary resuscitation (CPR) has seen many changes over the past several decades. Recently, a science advisory board for the American Heart Association recommended compression (hands) only CPR for adults experiencing sudden cardiac arrest outside of an acute care setting. This science advisory replaces the 2005 American Heart Association (AHA) Guidelines for CPR for bystanders witnessing a sudden cardiac arrest outside of a hospital.

This recommendation was put forth in light of the need to increase the prevalence and quality of bystander CPR (AHA, 2008). CPR saves lives, but because disease continues to concern many laypersons, CPR has been avoided in the past because of the mouth-to-mouth (rescue breathing) resuscitation component. With Americans growing older and more people with serious, chronic illnesses remaining active in the community, there are increasing numbers of out-of-hospital emergencies. To further complicate matters, the public is becoming increasingly apprehensive about offering to assist in resuscitation in an age where sexually transmitted and other diseases are of increasing concern. Recent studies show that the most common reason for the public’s unwillingness to help victims in an emergency is a reluctance to provide mouth-to-mouth resuscitation.

On the flip side, several recent human studies support the need to encourage the public to participate in rescue efforts, even if it only includes chest compressions. These studies have shown that compression only CPR performed by a bystander may reduce the time to initiate CPR, and result in the delivery of a greater number of chest compressions with fewer interruptions during the first few minutes of cardiac arrest, than traditional (rescue breathing and chest compressions) CPR (AHA, 2008).

The concern with this recommendation is that rescue breathing is a critical component of asphyxia-precipitated cardiac arrests, such as drowning, airway obstruction, apnea (drug overdose) or prolonged cardiac arrest. For these situations, hands only CPR would not be sufficient. However, for the majority of other sudden cardiac arrest situations in adults outside of a hospital, chest compressions alone are still preferable to delayed action or no CPR at all.

The Advisory Committee has recommended that all victims should receive, at a minimum, high quality chest compressions (chest compressions of adequate rate and depth with minimal interruptions) while the community emergency medical response system is being activated. Even if a bystander has not been trained in CPR, chest compressions should still be delivered until Emergency Medical Services arrives. Similarly, if a bystander has been trained in CPR but is not confident of their ability to provide traditional CPR, hands only CPR is strongly recommended.

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