Hands-Only CPR - Everything You Need to Know

Introduction

Globally, out-of-hospital sudden cardiac arrest (SCA) continues to be one of the leading causes of fatalities. Receiving cardiopulmonary resuscitation (CPR) from bystanders (a person standing near and witnessing the event but not related to it) markedly improves the survival rate of SCA victims. However, most out-of-hospital cardiac arrest victims do not receive lifesaving CPR first aid because of the complexity of standard CPR techniques and the lack of training among bystanders.

This highlights the need to educate and train the public with simpler but effective CPR techniques and encourage them to participate in providing CPR when they witness any sudden collapse of an adult. Hands-only CPR (HO-CPR) is an improvised method of CPR that significantly increases the survival chances in sudden cardiac arrest victims, especially in out-of-hospital environments.

What Is the Difference Between Standard CPR and Hands-Only CPR?

Standard cardiopulmonary resuscitation (STD-CPR) is an emergency lifesaving technique that helps to revive individuals who have collapsed due to sudden cardiac arrest. It involves periodic compressions alternated by mouth-to-mouth resuscitations. This procedure requires a lot of skilled training.

Some of the common barriers to performing conventional or standard CPR by bystanders are as follows:

• Concerns associated with disease transmission while giving mouth-to-mouth ventilation cause reluctance among bystanders to perform CPR.

• Panic among CPR-trained bystanders in out-of-hospital cardiac arrest scenes is cited as a barrier for STD-CPR.

• Fear of causing harm to the victim is also a failing reason to perform conventional CPR.

Research studies show that eliminating the mouth-to-mouth contact expectation during conventional CPR improves esthetics and minimizes potential bystanders’ concerns about infection. Simplifying CPR training also enhances the ability of the trainees to learn and execute proper chest compressions. Lastly, eliminating ventilation instructions reduces the duration where increased time is directed to the commencement of uninterrupted chest compressions resulting in effective resuscitations.

Hands-Only CPR

Hands-only CPR, also called compression-only CPR, reduces the duration of initiating CPR as it involves delivering an increased frequency of chest compressions with minimal interruptions in the first crucial minutes following out-of-hospital sudden cardiac arrest in adults.

Studies show that these compression-only resuscitations reduce the additional cognitive and emotional burdens on trained bystanders who are otherwise seen performing more complex psychomotor tasks in standard CPR. Also, hands-only CPR is relatively easy for a bystander to perform who needs to be adequately trained in conventional CPR techniques.

What Are the Steps Involved in Performing Hands-Only CPR?

The guidelines and recommendations for performing hands-only CPR are formulated by the American Heart Association (AHA) Emergency Cardiovascular Care (ECC) Committee based on the reports and evaluation of recent clinical studies. In hands-only CPR, chest compressions could be given at 100 to 120 compressions per minute without rescue breaths. The following steps can be followed for hands-only CPR.

Before Initiating Hands-Only CPR:

• The victim and the scene where the victim collapsed should be inspected thoroughly. The scene should be a safe place to carry out CPR. The victim should be tapped on the shoulder to see for any response and be inspected for vital signs such as periodic normal breathing and pulse rate.

• A call should be made to emergency ambulance services for assistance.

• Compressions should be started only if the victim is unresponsive.

Steps to Perform Hands-Only CPR:

• The victim should be on their back on a flat, firm surface with adequate ventilation.

• The bystander should kneel beside the victim so that the bystander's knees should be separated for about a shoulder width near the victim’s body.

• Proper hand placement should be followed. The heel of one hand of the bystander is placed in the center of the victim's chest, and the other is placed on its top.

• The fingers of the bystander should be interlaced to ensure they are above the chest.

• The correct body position of the bystander is that their shoulders should be directly over their hands and elbows locked to keep the arms straight.

• The compressions should be given continuously. They should be pushed hard and fast, compressing the victim’s chest to at least 2 inches with 100 to 120 compressions per minute, allowing the chest to recoil and return to its original position following each compression.

• Compressions are to be continued till the arrival of assistance.

• Delivering continuous chest compressions helps improve blood circulation during cardiac arrest, which is vital for keeping a person alive for crucial minutes.

When Should Hands-Only CPR Be Performed?

The AHA ECC Committee has thoroughly assessed the potential considerations and simplifications of CPR techniques to increase the chances of survival.

Hands-only CPR is recommended under the following conditions as

• Only for adult victims who experience sudden cardiac arrest in the out-of-hospital environment.

• The sudden collapse of adult individuals due to ischemic attack.

• Collapse after witnessing signs persistently related to myocardial infarction.

However, hands-only CPR is not recommended in the following situations-

• Unwitnessed cardiac arrest.

• Cardiac arrest in children.

• Cardiac arrest of noncardiac origin.

• Victims of drowning.

• Trauma.

• Airway obstruction.

• Acute respiratory diseases.

• Apnea due to drug overdose.

What Are the Limitations of Hands-Only CPR?

There are certain clinical situations where ventilation or rescue breaths are essentially needed for lifesaving but are not provided by hands-only CPR, such as drowning, asphyxial arrest, and pediatric age groups. These conditions require ventilation intervals following cardiac arrest when rescue breaths become critical for survival.

Also, trained bystanders need to clarify this to prioritize the type of CPR (conventional CPR or hands-on CPR). New modifications in hands-only CPR are needed to improve bystanders’ ability to deliver effective compressions and rescue ventilations.

What Are the Benefits of Hands-Only CPR?

Research studies have proven that hands-only CPR techniques are as effective as conventional CPR.

Some of its added advantages are as follows -

• It could be performed by a bystander who is not trained in conventional CPR.

• It increases blood circulation in adults who experience collapse with circulatory failure.

• Hands-only CPR reduces the fatigue in bystanders while performing resuscitation procedures.

• It reduces the panic among bystanders who are delivering CPR.

• Resuscitation skills in hands-only CPR could be effectively taught to schoolchildren of higher grades (above 14 years of age) through training services such as Red Cross, thereby increasing the proportion of trained bystanders who could be helpful in out-of-hospital situations.

Conclusion

Hands-Only CPR is an emergency life support first aid where effective chest compressions are given to improve blood circulation during sudden cardiac arrests. It is easier to perform and does not need complex training, which facilitates even less trained bystanders to provide CPR and increases the survival chances of the cardiac arrest victims.