Hands-Only cardiopulmonary resuscitation (CPR) involves continuous chest compressions without rescue breaths. This simplified technique is an immediate intervention for an adult who suddenly collapses, designed to be performed by untrained bystanders until professional medical help arrives. The purpose of Hands-Only CPR is to keep oxygenated blood circulating to the brain and other vital organs, buying time during a sudden cardiac emergency. Maintaining high-quality compressions for as long as possible is crucial for effectiveness.
The Default Standard: Continuous Compressions
When a person is found unresponsive and not breathing normally, compressions must begin immediately and continue without interruption. This continuity is necessary because compressions manually pump blood out of the heart, ensuring sufficient blood flow to the brain and heart muscle. Brief pauses cause an immediate drop in perfusion pressure, which significantly reduces the effectiveness of the rescue effort.
Current guidelines specify compressions should be delivered at a rate of 100 to 120 per minute, often compared to the rhythm of “Stayin’ Alive.” Compressions must be firm, pushing down on the center of the chest to a depth of at least two inches (but not greater than 2.4 inches) for an average adult. Allowing the chest to fully recoil after each compression is important, enabling the heart to refill with blood before the next pump. This maximizes the circulation of the victim’s remaining oxygen supply until advanced care arrives.
Criteria for Ceasing Compressions
The lay rescuer acts as a temporary life support system. There are four specific situations that determine when compressions should stop:
- Arrival of professional help: The most definitive reason to stop is the arrival and assumption of care by trained emergency medical services (EMS) personnel or another qualified first responder. They are equipped with advanced tools and training and will instruct the rescuer when they are ready to take over.
- Signs of life: The victim shows clear signs of life, such as beginning to move purposefully, coughing, or starting to breathe normally. It is important to differentiate normal breathing from agonal breathing (abnormal gasping or snorting), which is ineffective and requires CPR to continue.
- Rescuer exhaustion: Physical exhaustion, particularly if the rescuer is alone, is a practical reason to stop. Maintaining the correct depth and rate is physically demanding, and compressions that are too shallow or slow become ineffective. If multiple rescuers are present, switching every two minutes is ideal.
- Scene safety: The immediate safety of the rescuer must always be prioritized. If the scene suddenly becomes unsafe due to hazards like traffic, fire, or falling debris, the rescuer should immediately stop compressions and move to a safer location, if possible.
Immediate Steps After CPR Ceases
The action taken immediately after stopping compressions depends on the reason for the cessation.
If EMS Takes Over
If EMS or another trained professional takes over, the rescuer should step back but remain available to provide a concise summary of events. This summary should include the victim’s history, the estimated duration of the cardiac arrest, and how long compressions were performed.
If the Victim Revives
If the victim revives, showing signs of purposeful movement and normal breathing, the rescuer should immediately place the person into the recovery position. This position involves rolling the victim onto their side with the top leg and arm supporting them. The recovery position helps keep the airway open and allows fluids to drain safely from the mouth. The rescuer must then continuously monitor the victim’s breathing and responsiveness until professional help arrives.
If Stopping Due to Safety or Exhaustion
If compressions are stopped due to rescuer exhaustion or an unsafe scene, the rescuer should remain with the victim, if safety allows, and monitor the situation. The rescuer should be ready to resume compressions if another person arrives or if the immediate danger passes. They should also keep the emergency dispatcher updated on the situation.