Hands-Only CPR: When and How to Do It

I’m frequently asked if giving breaths has been eliminated from CPR now that the CPR guidelines have been updated. The simple answer is no, the breaths are still instructed in traditional CPR classes. However, there has been a big push, especially by the American Heart Association, to teach a version of CPR without breaths. This approach is often called “hands-only CPR”.

In short, hands-only CPR is fast, deep compressions on a victim’s chest. If someone doesn’t respond to your efforts to wake them, and their breathing is irregular or they aren’t breathing, you push straight down on an adult’s chest at least 2 inches at a rate of at least 100 compressions a minute. This is a skill you need to practice with an instructor on a manikin, so I’m not going to go into further detail on how to perform this skill.

Hands-only CPR has many advantages over traditional CPR: it’s simple to do, it reduces the risk of disease   transmission  while doing CPR, and research shows it’s as effective or more effective when used appropriately.

Hands-only CPR is an acceptable approach when you witness someone suddenly collapse. If this is an adult, it’s probably because of cardiac arrest (a heart attack). The victim still has several minutes of oxygen in their blood because they were breathing moments before they collapsed. The goal of hands-only CPR is to circulate that oxygenated blood throughout their body. By continually compressing their chest, you are literally squeezing blood through their heart so it reaches the brain and organs. Those compressions will buy the victim valuable minutes until emergency medical personnel arrive.

However, hands-only CPR isn’t always the best approach. If the victim has become unconscious and isn’t breathing normally because of an airway emergency, they need CPR with breaths. Asthma, severe allergies, choking, drowning and suffocation are all examples of airway emergencies that can lead to a victim who is unconscious and not breathing normally. Because these victims are lacking oxygen, they need rescue breaths, along with chest compressions.

Children and infants usually have healthy, strong hearts so if they become unconscious, the cause is usually not cardiac related. Most likely they are suffering from an airway emergency. This is why every parent who takes a CPR class should learn to do CPR with breaths. Unless a CPR class says it’s a hand-only class, all American Red Cross and American Heart Association CPR classes will teach you how to give rescue breaths along with compressions.