June 4, 2010
Dear Mayo Clinic:
What is continuous cardiopulmonary resuscitation (CPR)? Does it replace the CPR I learned years ago?
Continuous cardiopulmonary resuscitation (CPR), known as compression-only CPR or hands-only CPR, is easy to learn, remember and do. Because of its simplicity and effectiveness, it can replace conventional CPR (with mouth-to-mouth breathing) in many circumstances.
Hands-only CPR doesn't involve mouth-to-mouth breathing. It's simply hard (2 inches deep), fast (100 per minute) compressions administered to the center of the chest. The compressions circulate oxygenated blood to sustain the brain and body in the early minutes of a cardiac arrest.
In 2008, the American Heart Association (AHA) endorsed hands-only CPR in certain situations. If you as a bystander see an adult suddenly collapse, the AHA advisory statement says:
By promoting hands-only CPR, health care organizations are hopeful that more bystanders will step up to help cardiac arrest victims. An estimated 300,000 Americans have a cardiac arrest outside of the hospital every year. When a bystander administers CPR, the likelihood of survival can double or triple.
Unfortunately, bystander CPR doesn't happen often enough. Estimates suggest that bystander CPR occurs for one-fourth to one-third of out-of-hospital cardiac arrests. There are many possible reasons why this number isn't higher. Too few people have been trained in CPR, and studies show that those who have been trained in conventional CPR forget the details within months. Given the panic in a cardiac arrest situation and poor recollection of training, conventional CPR is a challenge to perform. Additionally, bystanders can be reluctant to do mouth-to-mouth breathing and can be afraid that they will do something wrong, causing harm to the victim.
Hands-only CPR overcomes many of these obstacles. There's little to remember — no compression-to-breathing ratios; the squeamish factor goes away with no required breathing; and it is simpler and less time consuming to teach.
If you see an adult suddenly collapse who is not breathing normally, shake the person and ask loudly if he or she is OK. If you don't get a response, call 911 or, better yet, have another bystander call. Then start rapid, firm compressions in the middle of the chest.
Don't take the time to check for a pulse. In 2005, AHA guidelines dropped the pulse check for lay rescuers because it is too difficult. Even doctors and nurses have a difficult time finding a pulse under stressful conditions. If an unresponsive adult sudden-collapse victim is not breathing normally, start hands-only CPR. In fact, many cardiac arrest victims are still gasping but need CPR. The best immediate care is to keep the heart pumping without delay.
There are situations where conventional CPR is still the first choice. Children benefit from breathing and chest compressions. Conventional CPR also is recommended for adults in the event of drowning or an overdose that results in cardiac arrest. Remember that continuous chest compressions are better than doing nothing at all, even in these circumstances.
Early research suggests an uptick in bystander CPR with this easier technique, and anecdotally we are seeing great interest in hands-only CPR. Check out Mayo Clinic's Medical Edge video to see a demonstration. Search "Mayo CPR" on YouTube. More than 4 million viewers have watched. Another good Web resource is www.azshare.gov.
You can learn the basics of hands-only CPR in 60 seconds. It's a minute that could one day help save a life.
— Tyler Vadeboncoeur, M.D., Emergency Medicine, Mayo Clinic, Florida