March 31, 2008 -- When it comes to saving the life of someone whose heart has suddenly stopped, it may be best for bystanders to keep it simple and use chest compressions.
The American Heart Association is issuing a "call to action" for bystanders who are not trained in conventional CPR to use only their hands, without the rescue breathing, in the crucial moments after they witness an out-of-hospital sudden cardiac arrest, when the heart stops beating.
CPR stands for cardiopulmonary resuscitation. It's intended to keep blood moving in people whose hearts have stopped and help keep someone alive until an emergency medical team arrives.
Conventional CPR includes two parts. One part is mouth-to-mouth resuscitation, also known as the "breath of life." The second part is chest compressions, when you push down hard and fast on a person's chest, more than once a second, pressing down at least an inch and a half before releasing.
"Many times people nearby don't help because they're afraid that they will hurt the victim and aren't confident in what they're doing," says Michael Sayre, MD, chairman of the AHA's statement writing committee. Sayre is associate professor in the Ohio State University department of emergency medicine in Columbus.
Sayre says that by using what is called hands-only CPR, or chest compressions, "bystanders can still act to improve the odds of survival, whether they are trained in conventional CPR or not."
According to the AHA, more than 300,000 U.S. adults die annually from sudden cardiac arrest outside the hospital.
The AHA's 2005 recommendations urged bystanders to use compression-only CPR only if they were unable or unwilling to give rescue breaths. This update follows recent studies and the consensus of the AHA's Emergency Cardiovascular Care Committee.
These are the recommendations: If you are witness to a sudden collapse of an adult, call 911 and start chest compressions hard and fast in the middle of the chest.
If the bystander isn't trained in CPR or is not confident in being able to do rescue breaths, then they should only do hands-only CPR until emergency medical assistance arrives or an automated external defibrillator (AED) is available for use.
If the bystander was trained in CPR and is confident in being able to provide rescue breaths with minimal interruptions to chest compressions, then they should give CPR with a 30:2 ratio of chest compressions to breaths or hands-only CPR and continue until an AED is available or emergency medical providers arrive to help.
Newer studies have found that in people with out-of-hospital cardiac arrest, survival numbers were comparable between those who received chest-compression only CPR and conventional CPR.
The researchers also note it could take longer for someone trained in traditional CPR to get it going and that people giving chest compressions alone get to it faster with fewer interruptions.
Research shows that while bystander CPR can more than double a person's chances of surviving cardiac arrest, in most cities it is performed in only about 27% to 33% percent of the cases. Chest compression-only CPR may help lower bystander reluctance to perform CPR.
The AHA is also recommending changes in the way CPR is taught, streamlining the technique by focusing more on how important chest compressions can be in keeping someone alive until they can get to a hospital.
Some 94% of sudden cardiac arrest victims die before reaching the hospital, according to the AHA. On average, only 24% of cardiac arrests that occur outside of a hospital have had a bystander perform CPR.
How can you tell if someone's heart has stopped beating? According to the AHA, it's when the person collapses, does not respond to gentle shaking, stops breathing after two rescue breaths, and is still not breathing, coughing, or moving.
If you do give someone CPR, remember to call for help -- 911 -- immediately as it's intended only as a short-term measure until emergency medical help arrives.
The hands-only CPR technique is only for adults whom you have seen collapse outside the hospital. Hands-only CPR is not to be used for children or infants or an adult whose heart has stopped because of non-cardiac causes such as a drug overdose or near drowning. In those cases, the AHA says conventional CPR with breaths is still the best technique to perform. The AHA still encourages people to learn conventional CPR at which time they will also learn how to do compression-only CPR.
That statement and new recommendations are published in the April 29 edition of Circulation.