D19-SummitHands Only CPR


Clarification: �Hands-Only CPR�

April 4, 2008

To All ECSI Educational Center Coordinators and Instructors:






As you may be aware from the extensive news coverage of the last few days, the American Heart Association has released information positioned as a "2005 Guidelines clarification" regarding CPR for bystanders. "Hands-Only CPR," also known as "chest compression-only CPR," is now receiving greater attention. The rationale for this clarification is based in both science and education. We have known for years that bystanders are reluctant to step forward and provide lifesaving care when confronted with a medical emergency due to a lack of knowledge about how to respond and the fear of doing something wrong. Getting bystanders to recognize a medical emergency, quickly access EMS, and do "something helpful" until qualified medical personnel arrive can save lives. We also know from limited research on cardiac arrest patient outcomes that either method-conventional CPR or chest compression-only CPR-achieves approximately the same results. Neither has been proven to be better than the other. More research is still needed.

However, since hands-only CPR is simpler and less invasive, an educational campaign is underway to encourage bystanders to perform this easier technique when confronted with a person in possible cardiac arrest. This technique has existed in our ECSI layperson CPR training materials even before the 2005 Guidelines. It is now time to place greater emphasis on this technique and encourage bystanders to learn the steps to perform it during an emergency. ECSI Education Center Coordinators and Instructors are encouraged to use their local resources to develop initiatives to help their communities improve bystander participation during emergencies.

Who Should Use This Technique?
This technique is NOT suggested to be used by all rescuers or for all victims of cardiac arrest. It is to be used by:

  • Laypersons during a witnessed collapse (possible cardiac arrest) of an adult
  • Those who are not trained in CPR
  • Those trained in CPR but uncertain of the steps

Those who are trained in layperson CPR AND who are confident about their skills can choose which method they want to use when confronted with an emergency.
Health care professionals will continue to perform conventional CPR.

When Should This Technique NOT Be Used?
This technique is NOT to be used for:

  • Children
  • Unwitnessed possible cardiac arrests
  • Arrests believed to be non-cardiac in origin

How Is This Technique Performed?
Bystanders are encouraged to provide only chest compressions, without providing any initial breaths or periodic breaths. The same hand position on the chest is used, and the same chest compression technique is used (rate of approximately 100 compressions per minute). Bystanders are encouraged to push deep and fast. Compressions are to be given for as long as possible, until EMS personnel arrive, or an AED is available and voice prompts can be followed. If a bystander gets tired and someone else is available to help, bystanders are encouraged to switch out as needed. For some people this may be every 2 minutes (about 200 compressions).

Will This Technique Replace Conventional CPR?
Conventional CPR will still be taught in our courses, and this alternative method will receive more emphasis for laypersons. Instructors will explain the caveats associated with its use to students in their courses.

Is This Technique Being Adopted Worldwide?
Not at this time.

What Are ECSI's Next Steps?
We will create a simple modified lesson plan for instructors to use when teaching our CPR courses, as well as a student handout that can be inserted in student manuals or issued separately. You will be notified when these are available, and you will be able to download these items at no cost from the Private Member's area of ECSI's website. We will update select online courses to reflect this alternative technique. We will also be working to support a national campaign that gets bystanders more involved.

If you are interested in reading the complete article published March 31, 2007 in the journal Circulation, you can view it at: http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.107.189380

If you have any questions regarding this alternative method, please send your inquiry to: Info@ECSInstitute.org.

Larry Newell, EdD, NREMT-P
National Executive Director
Emergency Care and Safety Institute

Craig Spector
2008 National Advisory Council Chairperson
Emergency Care and Safety Institute


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