Cardiopulmonary Resuscitation (CPR) is a life-saving technique used in emergencies when someone’s breathing or heart stops. CPR guidelines have evolved significantly, particularly regarding rescue breaths. These changes aim to improve survival rates and make the procedure more accessible to bystanders.
Evolution of CPR Guidelines
Historically, CPR guidelines emphasized “ABC” (Airway, Breathing, Circulation): opening the airway, providing rescue breaths, and then performing chest compressions. This approach was widely taught for decades following a 1966 scientific statement. However, medical research advanced, prompting a re-evaluation of these recommendations. This led to a gradual shift in focus, driven by new evidence on what truly makes a difference in cardiac arrest situations.
Why Compression-Only CPR Became the Standard
The shift toward compression-only CPR, also known as hands-only CPR, for untrained bystanders resulted from several findings. Continuous, high-quality chest compressions are now understood to be the most impactful component for maintaining blood flow to vital organs like the brain and heart during sudden cardiac arrest. In the initial minutes following collapse, a person often has enough oxygen stored in their blood to sustain these organs, making uninterrupted blood flow paramount.
A significant barrier to bystander CPR was the requirement for rescue breaths, which often caused hesitation. Concerns about disease transmission, lack of training, or discomfort with mouth-to-mouth contact deterred many from acting. Simplifying CPR to hands-only makes it more accessible and increases the likelihood that bystanders will initiate CPR immediately. Research, including studies supported by the American Heart Association (AHA), has demonstrated that for sudden cardiac arrest in adults, compression-only CPR is as effective as, or more effective than, conventional CPR with breaths when performed by untrained bystanders. Some studies showed a near doubling of 30-day survival rates with an increase in bystander compression-only CPR.
Current Guidance for Bystander CPR
Current guidelines for bystander CPR emphasize immediate action and simplicity, primarily recommending hands-only CPR for adults who suddenly collapse. The first step is to call 911 or your local emergency number immediately. Once emergency services are alerted, begin chest compressions without delay.
The technique for hands-only CPR involves pushing hard and fast in the center of the chest. Place the heel of one hand on the center of the chest, place the heel of your other hand on top, and interlace your fingers. Compressions should be delivered at a rate of 100 to 120 beats per minute, which can be timed to the rhythm of songs like “Stayin’ Alive.” Allow for full chest recoil after each compression and minimize interruptions. This guidance primarily applies to adults experiencing sudden cardiac arrest, and any attempt at CPR is considered better than no attempt at all.
Situations Where Rescue Breaths Are Still Necessary
While hands-only CPR is recommended for sudden cardiac arrest in adults, rescue breaths remain important in specific situations. For children and infants, rescue breaths are especially important because their cardiac arrest often results from respiratory issues, such as drowning or choking. Victims of drowning, drug overdose, or severe choking often experience a lack of oxygen that precedes cardiac arrest, making breaths a necessary component of their care.
Individuals who collapse due to known respiratory problems, like a severe asthma attack, also benefit from rescue breaths. In these scenarios, the primary problem is a lack of oxygen, and providing ventilations can address this underlying cause. Trained professionals or individuals comfortable and proficient in delivering full CPR, including both compressions and breaths, should continue to do so in all appropriate situations.