Forget CPR, Give CCR Instead

Adults Who Collapse Need Chest Compression, Not Mouth-to-Mouth

Medically Reviewed by Louise Chang, MD on March 11, 2008
From the WebMD Archives

March 11, 2008 -- For adults who collapse after cardiac arrest, mouth-to-mouth resuscitation is dead.

A new lifesaving technique, cardio-cerebral resuscitation, is much more likely to save lives than the old cardiopulmonary resuscitation or CPR technique, an Arizona study shows.

It's a big change. Instead of using their mouths to give the "breath of life," rescuers should use their hands to keep blood moving to the hearts and brains of cardiac arrest victims, says Bentley J. Bobrow, MD, medical director of Arizona's emergency services system and an emergency physician at Mayo Clinic Hospital, Scottsdale.

"It is not cardiopulmonary, but cardio-cerebral resuscitation -- you need to feed the brain, not the lungs," Bobrow tells WebMD. "That is why the emphasis is on getting the blood flowing and not interrupting it, even for ventilation."

Stopping chest compressions -- even for mouth-to-mouth emergency breathing -- wastes precious time.

"When that person collapses, your hands are their heart," Bobrow says. "If your hands are not on their chest, they have no heartbeat."

New Advice: Don't Stop Chest Compressions

The old CPR technique called for rescuers to give 30 chest compressions followed by two quick emergency breaths into the mouth of the victim, notes Mary Ann Peberdy, director of the resuscitation program at Virginia Commonwealth University.

"It takes about halfway through that chest-compression cycle to build up a marginal pressure to the heart and brain," Peberdy tells WebMD. "As soon as you stop, that pressure almost immediately falls to zero. After giving ventilation, it takes halfway though next cycle to get the pressure back up -- so you are constantly chasing your tail."

Cardiac arrest victims have oxygen dissolved in their blood. Their immediate problem isn't getting more oxygen into the blood, it's getting that blood to the brain and to the heart.

When first responders used a professional version of the new technique, Bobrow and colleagues found, they saved three times more lives than they did with standard life-support techniques.

The new technique saved 8.6 times more lives among victims with the best chances of survival. Bobrow and colleagues -- including Gordon A. Ewy, MD, whose team developed the CCR technique -- report these findings in the March 12 issue of TheJournal of the American Medical Association. An editorial by Peberdy and colleague Joseph P. Ornato, MD, accompanies the study.

The study compared survival rates before and after emergency medical personnel from two Arizona cities were trained in the new technique.

Before the new technique, patients suffering cardiac arrest had a 1.8% chance of survival. The new technique increased the survival rate threefold, to 5.4%. Among patients whose cardiac arrest was witnessed and who got emergency shocks from a defibrillator, the survival rate increased 8.6-fold to 17.6%.

How to Do CCR for Cardiac Arrest

A cardiac arrest isn't the same as a heart attack.

"A heart attack is a plumbing problem, and a cardiac arrest is electrical," Peberdy says. "A heart attack is a block in a pipe, and unless the pipe unclogs the heart muscle will die. A cardiac arrest is a sudden catastrophic electrical problem where the heart cannot beat at all. Cardiac arrest equals sudden death. You die unless you are resuscitated."

People who suffer cardiac arrest suddenly collapse. In adults, a collapse is almost always due to cardiac arrest.

"If someone suddenly collapses, you can help, but if you do nothing, that person will almost certainly die," Bobrow says. "Activate the 911 system, position the victim with head tilted back so the airway is open, and then immediately start rapid, forceful chest compressions. Lock your hands together one on top of the other, put the heel of the lower hand in the center of the victim's chest, and push hard and fast, 100 times per minute. If you are lucky enough to have an AED [automated external defibrillator], attach it to the victim and follow the commands."

Don't worry about mouth-to-mouth resuscitation or compression-to-breath ratios, Bobrow says. And don't worry about pushing too hard. The chest has to be depressed about 2 inches. Even if you crack the victim's ribs, you'll be doing much more good than harm.

"You can't make anything worse. All you can do is help," Bobrow says. "Keep up the compressions until help arrives. If you get tired, have another person take over for a while."

"The best message we can send people is, if they witness a cardiac arrest, push hard, push fast, and don't stop until the emergency responders get there," Peberdy says.

Mouth-to-mouth resuscitation still has a role in patients with respiratory arrest. But Bobrow and Peberdy say that the vast majority of adults who collapse have cardiac arrest. Since cardiac arrest is rare in children younger than 8 years of age, rescuers should suspect respiratory arrest when young children collapse. Traditional CPR is still recommended for these young children.

Show Sources


Bobrow, B.J. TheJournal of the American Medical Association, March 12, 2008; vol 299: pp 1158-1165.

Peberdy, M.A. and Ornato, J.P.  TheJournal of the American Medical Association, March 12, 2008; vol 299: pp 1188-1190.

Bentley J. Bobrow, MD, emergency physician, Mayo Clinic Hospital, Scottsdale, Ariz.; medical director, Bureau of Emergency Medical Services and Trauma system, State of Arizona.

Mary Ann Peberdy, MD, associate professor of internal medicine and emergency medicine and director, resuscitation program, Virginia Commonwealth University, Richmond.

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