Hands-only cardiopulmonary resuscitation was introduced in 2008 as a way to get lay people to act immediately upon witnessing a sudden cardiac arrest (SCA). Now, more than 10 years later, research shows that this might actually be the best course of action for untrained bystanders.
To be better prepared to face an emergency, we’ve prepared this guide on the pros and cons of hands-only CPR vs. traditional CPR.
Rates of Bystander Response
The American Heart Association (AHA) notes that lack of confidence is one of the key reasons why bystander-initiated CPR is often absent during a cardiac emergency.
Bystander preparedness is important, but many people simply don’t know what to do. Compression-only CPR is much easier to learn and perform than rescue breaths, and a quality defibrillator will guide the user through the process of delivering chest compressions.
Studies have found that only about 46% of out-of-hospital cardiac arrest sufferers received bystander CPR in 2017. While the numbers are improving, this still leaves a major gap when it comes to out-of-hospital sudden cardiac arrest treatment. CPR can double or even triple a person’s chances of survival, so the AHA is passionate about encouraging any incidence of bystander intervention during an emergency.
How Chest Compressions Help
When someone is a victim of a sudden cardiac arrest, their heart stops beating normally, their pulse disappears, and they stop breathing. When this happens in an out-of-hospital setting, the chances of survival are next to none—unless a bystander springs into action.
After the victim’s heart stops beating, the most important thing is to keep the blood circulating throughout the victim’s vital organs to prevent organ death until paramedics arrive. Compressions perform this vital role if performed immediately upon collapse, which is why assistance from bystanders is so important.
Where Rescue Breaths Come In
In traditional CPR, participants learn how to perform chest compressions as well as rescue breaths, at a ratio of 30:2. Rescue breaths fill the lungs with air, providing oxygen to the victim’s bloodstream. The oxygenated blood is then pumped manually around the body with the 30 chest compressions that follow.
The effectiveness of hands-only CPR vs. traditional CPR depends on the age of the victim and the situation. While the American Heart Association notes that hands-only CPR is effective for teens and adult patients, traditional CPR (with breaths and compressions) is recommended in the following situations:
- Sudden cardiac arrest in infants and children
- Drug overdose
- Cardiopulmonary arrest due to breathing problems
- Prolonged cardiac arrest
Rescue breathing for infants and children has shown to be especially important, though you should still proceed with chest compressions if you’re not sure how to perform mouth rescue breaths.
How Effective Is Hands-Only CPR During Medical Emergencies?
While it might seem counterintuitive, an analysis of studies showed that hands-only CPR can actually be more effective than traditional CPR in an out-of-hospital cardiac arrest situation. One of the studies in particular, from the SOS-KANTO Study Group, found that hands-only care can result in a better neurological outcome for the patient.
In a compilation of three randomized trials identified by the research team, 11.5% of the SCA patients who received hands-only CPR were still alive at hospital discharge, whereas only 9.4% of the SCA patients who received traditional (breath-and-compression) CPR were still alive at the time of hospital discharge. Additional studies have yielded similar results.
Hands-only CPR proved more effective than traditional CPR for the following reasons (among others):
- Bystanders felt more confident to apply hands-only CPR.
- Mouth-to-mouth ventilation was often of poor quality.
- Too much time was lost during attempts at mouth ventilation.
This comparison of outcomes is revealing. Researchers in more than one observational study have concluded that it’s better for an untrained bystander to apply hands-only CPR rather than attempt traditional CPR. This position is supported by the AHA, the American College of Cardiology, and the American Society of Anesthesiology.
How to Apply Hands-Only CPR
If you ever see someone suddenly collapse, it’s probable that they are a victim of a sudden cardiac event. Over 350,000 SCAs occur outside of a hospital setting every year, and 20% occur in public places like airports and sporting facilities. Your immediate help as a prepared bystander could be the difference that saves their life.
Check for Safety and Consciousness
Before attempting hands-only CPR, check that the area is safe and see whether the person is conscious by talking to them in a loud, clear voice, and shake them gently to encourage a response.
Send for Help
If the victim doesn’t respond, send one bystander to call 911 and another bystander to get an AED (automated external defibrillator) if there is one available onsite. If you are alone, call 911 if the victim is an adult or after two minutes of CPR if the victim is an infant or child under eight.
Look for Signs of Breathing
CPR is only effective if the victim isn’t breathing. To assess breathing, look for rises and falls in the victim’s chest and observe their nose and mouth for movement of air. If there are no signs of breathing or only occasional gasps, it’s time to begin chest compressions.
Perform Chest Compressions
Chest compressions keep the blood circulating until a defibrillator or emergency services arrive. Follow these instructions to perform hands-only CPR:
- Roll the victim carefully onto their back.
- Remove any clothing covering their chest.
- Kneel beside the victim and place the heel of one hand in the center of their chest, on the breastbone. Put the heel of the other hand on top of the first hand, interlacing your fingers.
- Push straight down in a repetitive motion at a rate of 100 to 120 compressions per minute (or to the beat of Stayin’ Alive by the Bee Gees). The depth of the compression is roughly ⅓ of the victim’s chest depth:
- 2-2.4 inches (5 to 6 cm) for an adult (two hands)
- 2 inches (5 cm) for a child (one or two hands)
- 1.5 inches (4 cm) for an infant (two fingers)
- Feel the chest rise between compressions.
- Continue with chest compressions until emergency services or an AED arrives.
For more information, refer to our comprehensive guide on how to perform CPR.
Special Situations When Hands-Only CPR Is Best
Sometimes, hands-only CPR is absolutely necessary, so it’s best to be prepared with this simplified version of resuscitation to be ready for these specific situations:
The Victim or Bystander Might be Contagious
Mouth-to-mouth contact can lead to life-saving care but is not advised when there’s a possibility of infectious disease. During the COVID-19 pandemic, particularly, first responders are advised to use compressions without mouth-to-mouth contact to prevent the infection of either the victim or person applying CPR.
If a sterile CPR mask is available, a bystander with up-to-date training in CPR or basic life support might still choose to provide mouth ventilation as the mask has a one-way valve. However, even trained bystanders may choose to stick with chest compressions to avoid infecting the victim.
The Bystander’s Training Is Out of Date
Bystander cardiopulmonary resuscitation requires special care when rescue breathing is involved. Rescue breathing is only effective if performed correctly, i.e.:
- The chin is lifted and the head tilted slightly back
- The rescuer’s cheek blocks off the nasal passages completely
- The chest rises visibly when the breath goes in
If not performed correctly, ventilation is not effective and only wastes valuable time that would better be spent compressing the chest. If the bystander has not attended CPR training in the last five years, it’s best for them to stick with hands-only CPR.
Ensuring the Best Rate of Survival
In an ideal world, everyone would be CPR-trained and practice regularly with feedback on their technique. However, in the real world, hands-only CPR is an effective way to get bystanders involved. If you’re not sure whether to use hands-only CPR vs. traditional CPR, consider the following factors:
- Is the victim a teen or adult with a witnessed collapse?
- Is there a chance of contagion?
- Is your CPR training out of date?
If you answered “yes” to any of these questions, immediately perform hands-only CPR while sending another bystander to call 911 and find the nearest AED. The device will provide you with the basic steps for defibrillation and will scan the patient’s heart for a shockable cardiac rhythm, providing an electric shock if warranted. If no shockable rhythm is found, the AED will prevent you from shocking the patient.
If the victim is an infant or child and you have recent CPR training, the guidelines recommend performing traditional CPR with rescue breathing in order to give the child the greatest chance of survival. This also applies if the patient is a victim of:
- Drug overdose
- Respiratory problems
- Prolonged downtime (greater than 5 minutes)
In these cases, an untrained bystander can still perform chest compressions until someone with recent CPR training can be found.
Remember, every second counts when it comes to sudden cardiac arrest, and any attempt at out-of-hospital cardiopulmonary resuscitation can improve survival rates. If you’re ever in doubt between hands-only CPR vs. traditional CPR, start compressions and call 911. Anyone can provide cardiovascular care in an emergency, and you just might be the one to save a life.