Hands-Only CPR and When to Add the Breathing | The Survival Doctorby James Hubbard, MD, MPH

A child collapses; there’s no sign of life. You call for help and start CPR. But wait. Didn’t you hear somewhere that they say now not to do the respirations part? Just do Hands-Only CPR? Or are kids one of the exceptions?

Well, whatever you do, do something, and do it quick.

When to Add the Breathing

These days, Hands-Only CPR is the way to go in most situations for people who aren’t medical professionals. It’s easier; it works as well as adding respirations, at least most of the time. And the feeling is, it’ll help more people act and act quicker.

But there are exceptions.

The American Heart Association recommends CPR with a combination of breaths and compressions for:

  • All infants (up to age 1)
  • Children (up to puberty)
  • Anyone found already unconscious and not breathing normally
  • Any victims of drowning, drug overdose, collapse due to breathing problems, or prolonged cardiac arrest

Source: American Heart Association, “Hands-Only CPR.”

But What Does That Mean?

Now, truthfully, I wonder about these guidelines.

With children with no signs of life, yes. Do the mouth-to-mouth (or mouth-to-nose-and-mouth). In fact, a breathing problem is usually what causes a child collapse in the first place. It’s usually the heart in adults.

But the last two?

  • Anyone found already unconscious and not breathing normally

Why do chest compressions on someone still breathing?

I think this may be a judgment call—that here, they’re talking about agonal breathing, which is kind of pseudobreathing. The person is basically dead, but a reflex makes the chest and diaphragm still contract and expand. It’s usually a kind of jerking expansion of the chest, and a little air gets sucked in. It normally happens about every 10–15 seconds or less.

But there are other people who are truly breathing, just having a little trouble. I’ve seen many a person zonked out on drugs or alcohol with labored breathing.

Now, sure, there’s a danger that someone like this could stop breathing altogether, but the first thing I’d do is make sure the airway is open. I’d do a jaw thrust, or, if I’d ruled out a spinal injury, I’d turn them on their side—something to make sure the breathing problem wasn’t being caused by the back of their tongue blocking their airway. Or you could try an oropharyngeal or nasopharngeal airway device if you know how to use one.


Prolonged cardiac arrest? What if you don’t know whether this is the case?

What to Do

Here’s my take from all this. You have to go on what you know—what you think best.

From the current recommendations, at least, you can’t go wrong doing proper chest compressions in someone who’s unconscious and not breathing. If you learn nothing else from CPR, learn how to do them and do them right.

Artificial respirations? I think you can probably remember to do them on kids and people who have drowned. (By the way, it’s prepubertal kids. If they have facial or underarm hair or breast development, it’s chest compressions only.)

With people who are unconscious and not breathing normally, it may be a judgment call.

In the end, you do what you can. And the vast majority of the time, in times of life and death, that’s a whole lot better than doing nothing.

Want certainty in what you do? It’s estimated that 60 percent of people who collapse in public and need CPR don’t get it. There’s no doubt of their outcome (certain death).

What about you? Would you know what to do?

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Photo: Flickr/The U.S. Army (cropped). CC BY 2.0.