Hands-only Cardiopulmonary Resuscitation (CPR) is a life-saving technique that emphasizes continuous chest compressions to maintain blood flow when a person’s heart has stopped. It allows bystanders to focus on pushing hard and fast in the center of the victim’s chest. This action artificially mimics the heart’s pumping function, circulating oxygenated blood until professional medical help arrives. Knowing when to cease these compressions is crucial, ensuring the victim receives the maximum benefit of the intervention.
Arrival of Trained Medical Personnel
The primary external factor dictating when to stop hands-only CPR is the arrival of trained medical professionals. The rescuer must continue chest compressions without interruption until emergency medical services (EMS), such as paramedics, police, or fire department personnel, are physically present and ready to take over care. Once these professionals arrive, they will assess the patient’s condition. The bystander should maintain the compression rate of 100 to 120 pushes per minute and a depth of at least two inches in adults until they are explicitly instructed to stop or until a trained provider physically relieves them. This seamless transition of care is important because any pause in compressions stops the artificial circulation of blood and oxygen.
Victim Shows Definitive Signs of Life
The return of effective, normal breathing or purposeful movement is a definitive reason to stop chest compressions. Normal breathing is characterized by regular, steady, and rhythmic breaths, distinct from the irregular and shallow breathing patterns associated with cardiac arrest.
Purposeful movement can include the victim opening their eyes, waking up, actively moving their limbs, or attempting to grab the rescuer. It is important to distinguish normal breathing from a phenomenon known as agonal breathing.
Agonal respirations are an abnormal pattern of gasping, snorting, or gurgling that can occur in early cardiac arrest cases. These are not effective breaths and are due to a lack of oxygen. If the victim exhibits this irregular, ineffective breathing, the bystander must continue chest compressions, as this is a sign of cardiac arrest, not recovery. If compressions are stopped and the victim loses these signs of life, the rescuer must immediately resume pushing hard and fast on the chest.
Rescuer Exhaustion or Scene Safety Concerns
The rescuer’s own physical condition and the safety of the surrounding environment are two rescuer-centric reasons to stop chest compressions. Performing high-quality compressions at the recommended depth and rate is physically demanding. A rescuer’s compression quality can decline significantly within just two minutes due to fatigue, making the compressions ineffective at circulating blood. Stopping is appropriate when the rescuer becomes physically unable to maintain this effective rate and depth.
If a second rescuer is present, the protocol is to alternate giving compressions every two minutes to prevent this fatigue and maintain high-quality CPR. The shift between rescuers should be completed as quickly as possible to minimize the interruption in chest compressions.
The rescuer must also stop immediately if the scene environment becomes unsafe. If a hazard develops, such as an active fire, a collapsing structure, or traffic moving too close, rescuer safety is paramount. The rescuer should attempt to move the victim to a safe area if possible before resuming compressions, but if the threat is immediate and unavoidable, they must prioritize their own life and stop the intervention.