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Hands-Only Resuscitation OK for Cardiac Arrest

New American Heart Association guidelines don't require ventilation

MONDAY, March 31 (HealthDay News) -- If you see someone collapse in a public place or at home and you think it might be a heart attack, start pushing on his or her chest as hard as you can and as often as you can.

Those are the latest instructions from the American Heart Association, which asserts that hands-only cardiopulmonary resuscitation (CPR) can be done in an emergency situation, even by people who have no training in the technique.

The statement, published in the April 29 issue of Circulation, does not rule out mouth-to-mouth breathing as part of CPR. "But we have learned enough to say that passers-by can save lives with chest compression alone," said Dr. Michael Sayre, an associate professor of emergency medicine at Ohio State University and chairman of the AHA committee that wrote the statement.

"We believe that approximately 250,000 Americans suffer cardiac arrest each year," Sayre said. "Perhaps 15,000 of them will live. We believe that getting more people to do CPR could probably save thousands of lives a year."

The details of traditional CPR -- how often and how hard to push -- can be ignored, Sayre said. "We've done a little bit of research to suggest that most people are not likely to push hard enough and it's difficult to push too hard or too fast," he said.

Dr. Benjamin S. Abella, clinical research director at the University of Pennsylvania Center for Resuscitation Science, added, "in a case of cardiac stress, it's probably unrealistic for a member of the public to know what 100 pushes a minute and 2 inches of depth are."

So the new guidelines work out to a simple two-step measure: First dial 911 to call for emergency medical help, then begin hands-only CPR.

"It's fairly clear that CPR, when done by any standard, can double or potentially triple survival," Abella said. "That is great enough to warrant any risk."

The hands-only advice also eliminates a potential hindrance to providing help -- fear of what might happen with mouth-to-mouth contact, Abella said. "This allows bystanders to do a simpler form of CPR that avoids mouth-to-mouth contact with a stranger," he said.

The new recommendation for hands-only CPR is an update to 2005 American Heart Association guidelines, which said bystanders should use compression-only CPR if they were unwilling or unable to provide breaths. Three studies published in 2007 showed no negative impact on survival when mouth-to-mouth ventilation was eliminated, the association statement said.

It's still best to have CPR done in the conventional way by medical personnel trained in the technique, the heart association said. The new recommendation applies only to bystanders who come to the aid of adult cardiac arrest victims outside a hospital setting.

Hands-only CPR should not be used on infants or children, or adults whose cardiac arrest is from respiratory causes such as drug overdose or near-drowning.

About 75 percent of all sudden cardiac arrests happen at home, the heart association estimates, and the new guideline applies in such cases: 911 first, hands-only CPR second.

More information

You can learn more about CPR from the American Heart Association.

SOURCES: Michael Sayre, associate professor, department of emergency medicine, Ohio State University School of Medicine, Columbus; Benjamin S. Abella, M.D., clinical research director, University of Pennsylvania Center for Resuscitation Science, Philadelphia; April 1, 2008, Circulation

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