Hands-only Cardiopulmonary Resuscitation (HOCPR) is a life-sustaining measure for a person experiencing sudden cardiac arrest. It focuses entirely on continuous, hard, and fast chest compressions to manually circulate oxygenated blood to the brain and other vital organs until professional help can take over. The lay rescuer must push in the center of the chest at a rate of 100 to 120 compressions per minute. While starting this intervention immediately can double or triple a person’s chance of survival, understanding when to stop pushing is equally important.
Arrival of Trained Personnel
The most common point to stop hands-only CPR is when trained emergency medical services (EMS) personnel arrive. These professionals possess advanced life support equipment and medical training beyond what a bystander can provide. However, the arrival of the ambulance does not signal an immediate halt, as a smooth transfer of care is paramount for continuity.
The lay rescuer must continue performing high-quality compressions without interruption until a member of the EMS team is physically ready to take over or specifically tells the rescuer to stop. This transition ensures the victim’s blood flow remains supported while professionals prepare equipment like a defibrillator or advanced airway devices. Maintaining support until the new rescuer’s hands are in position minimizes the time delay between manual and advanced circulation efforts. If other trained lay rescuers arrive, the initial rescuer should utilize them to switch roles every two minutes to prevent compression fatigue.
Rescuer Safety and Physical Limits
Two primary reasons unrelated to the victim’s status permit a rescuer to stop compressions: personal physical capacity and scene safety. Performing effective chest compressions is physically demanding, and quality degrades significantly, sometimes within just one minute. If a person is physically unable to continue pushing hard enough or fast enough to meet depth and rate requirements, the compressions become ineffective.
Stopping due to complete exhaustion is permissible, particularly if the rescuer is alone and cannot maintain the force necessary for quality compressions. Good Samaritan laws generally protect a lay rescuer who initiates and then must cease CPR due to physical fatigue. The rescuer must also stop immediately if the environment becomes unsafe, such as in the presence of fire, traffic hazards, or structural instability. Prioritizing personal safety is necessary, as an injured rescuer cannot help the victim.
Victim Recovery or Device Intervention
A significant change in the victim’s physiological status is a clear indication to stop hands-only CPR. The rescuer should cease compressions immediately if the victim begins to show definitive signs of life. These signs include purposeful movement, speaking, coughing, or the return of normal breathing.
It is important to differentiate between true recovery and gasping respirations, which are sometimes called agonal breathing. Agonal breathing is an abnormal, irregular gasping pattern that can occur during cardiac arrest and should not be mistaken for normal breathing. If the victim is only gasping, compressions must be continued until the victim’s breathing becomes regular and sustained.
Another temporary stop occurs with the use of an Automated External Defibrillator (AED). Compressions must continue while the device is retrieved and the pads are applied. The rescuer should pause only when the AED is turned on and ready to analyze the heart rhythm. If the AED advises a shock, compressions must be paused for delivery, but they must resume immediately afterward.