Hands-Only CPR (HOCPR) is an immediate, lifesaving intervention designed for adults who suddenly collapse from cardiac arrest. This bystander technique simplifies traditional cardiopulmonary resuscitation by focusing exclusively on forceful chest compressions, eliminating the delay associated with rescue breaths. The primary goal is to manually circulate oxygenated blood to the brain and vital organs until trained emergency medical services (EMS) arrive. Implementing this technique immediately can significantly improve a victim’s chances of survival outside of a hospital setting.
The Four Reasons to Stop Chest Compressions
A rescuer should maintain continuous chest compressions until one of four specific conditions is met.
The first reason to stop is if the immediate environment becomes hazardous to the rescuer or the victim, such as in the event of a fire, a collapsing structure, or heavy traffic. Rescuer safety must always take precedence, and compressions should be stopped to move to a safer location.
Compressions should also be stopped if the victim shows unequivocal signs of revival, which includes purposeful movement, opening their eyes, or beginning to breathe normally. It is important to note that gasping or snorting, sometimes called agonal breathing, is not considered normal breathing, and compressions must continue in that instance.
The third reason is if the rescuer becomes physically exhausted and can no longer maintain the proper rate and depth of compressions. If a second bystander is present and willing, they should take over immediately. If the rescuer is alone and cannot effectively push, they must stop.
The most common reason for stopping compressions is the arrival and takeover by trained medical professionals, such as paramedics, firefighters, or hospital staff. Once these personnel arrive, they will announce that they are taking control of the situation, and the bystander can step away.
Maintaining Quality and Minimizing Pauses
The effectiveness of Hands-Only CPR relies entirely on the quality and continuity of the compressions delivered. Compressions must be delivered at a specific rate, ideally between 100 and 120 compressions per minute, which is often likened to the rhythm of the song “Stayin’ Alive.” Maintaining this rate helps ensure a consistent flow of blood to the victim’s brain and heart muscle.
Beyond the rate, the depth of the chest compressions is just as important, requiring a downward push of at least two inches in the average adult. This depth is necessary to adequately squeeze the heart and pump blood effectively through the circulatory system.
Interrupting chest compressions severely diminishes the critical coronary perfusion pressure, which drives blood into the heart muscle itself. Even brief pauses, ideally lasting less than ten seconds, can cause this pressure to drop precipitously. This drop necessitates multiple subsequent compressions just to build the pressure back up to a therapeutic level.
Handing Off Care and Next Steps
When Emergency Medical Services (EMS) arrive, the transition of care from the bystander to the professionals must be smooth and informative. The rescuer should clearly communicate pertinent details to the incoming team. This information includes when the victim collapsed, how long compressions have been performed, and the victim’s current status.
If the victim shows clear signs of revival, compressions should cease, and the rescuer must immediately assess their breathing. If the victim is breathing normally but remains unresponsive, they should be carefully rolled into the recovery position. The recovery position helps keep the airway open and minimizes the risk of aspiration if the victim vomits.
A victim who has revived must be continuously monitored for changes in their breathing and responsiveness. The rescuer should remain with the victim, ready to restart compressions if the normal breathing stops again, until trained medical personnel officially take over care of the patient.