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Is hands-only CPR as effective as traditional CPR ? Wouldn't 30 chest compressions + 2 rescue breaths be more effective if the person doesn't have a pulse AND not breathing?

From my understanding (correct me if I'm wrong) by doing chest compression you manually make the blood continue to circulate the body in order to deliver oxygen to the organs (and most importantly, to the brain), but after some time (several minutes?) all the oxygen from the blood will be used up, and if the person is not breathing, that means that no new oxygen is entering the bloodstream, so that would mean that chest compressions alone won't provide oxygen to the brain anymore, so they would be useless... am I wrong?

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  • $\begingroup$ During CPR, you should push on the chest at a rate of at least 100 compressions per minute $\endgroup$ – user14930 Mar 14 '15 at 17:40
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    $\begingroup$ @MuditKapil I don't think that is what is being asked here. What's being asked is, if you are doing hands only CPR as opposed to CPR + rescue breathing aren't you just circulating the same O2 depleted blood? $\endgroup$ – L.B. Mar 14 '15 at 20:24
  • $\begingroup$ I taught CPR for 4 years for the Canadian Red Cross. In a very practical sense good quality hand-only CPR is what every lay person should be doing. Call 9-1-1 as fast as possible. Push hard, push fast and don't stop for interruptions. Either you caught the person in the 10 minute window where they are still oxygenated and medics/physicians can save them in which case breathes are not useful (blood ox is still high) or they're blood ox has dropped and likely noone can save them. Keep in mind a barely alive person has very little oxygen demands. $\endgroup$ – Artem Apr 7 '17 at 5:47
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The wikipedia page for CPR actually goes into some detail on this, going to block quote the section here for ease of access,

Compression-only (hands-only or cardiocerebral resuscitation) CPR is a technique that involves chest compressions without artificial respiration. It is recommended as the method of choice for the untrained rescuer or those who are not proficient because it is easier to perform and instructions are easier to give over a phone. In adults with out-of-hospital cardiac arrest, compression-only CPR by the lay public has a higher success rate than standard CPR. The exceptions are cases of drownings, drug overdose and arrest in children. Children who receive compression-only CPR have the same outcomes as those having received no CPR. The method of delivering chest compressions remains the same, as does the rate (at least 100 per minute). It is hoped that the use of compression-only delivery will increase the chances of the lay public delivering CPR. As per the American Heart Association, the beat of the Bee Gees song "Stayin' Alive" provides an ideal rhythm in terms of beats per minute to use for hands-only CPR. One can also hum Queen's "Another One Bites The Dust", which is exactly 100 beats-per-minute and contains a memorable repeating drum pattern. For those with non cardiac arrest and people less than 20 years of age, standard CPR is superior to compression-only CPR.

The American Heart Association has assembled some efficacy testing studies in the following review article, Hands-Only (Compression-Only) Cardiopulmonary Resuscitation: A Call to Action for Bystander Response to Adults Who Experience Out-of-Hospital Sudden Cardiac Arrest. Importantly, the human clinical studies reported no significant difference between those who received conventional cpr and those who received compression-only CPR. Some animal efficacy studies are noted, and with respect conventional CPR, the animals that didn't receive "rescue breaths" experienced a lower survival rate. In the end they note some limitations to hands-only CPR:

"...raised concerns about the possibility that recommending hands-only CPR for witnessed sudden cardiac arrest will, in fact, increase the complexity of decision-making for bystanders or that unresponsive victims of noncardiac medical emergencies (eg, drowning, drug overdose) will not receive rescue breathing."

"There may be situations in which ventilation alone could be life-saving but is not provided. There may be an interval after cardiac arrest when ventilations become absolutely critical for survival."

And as to the content in the second paragraph of the original post,

"It is important to acknowledge that during cardiac arrest without lung inflation and ventilation, there is a continuous decrement of blood oxygen saturation. At some point in time, the possible hemodynamic advantage conferred by continuous chest compressions (without ventilations) will be offset by this reduction in oxygen saturation, and the ultimate result will be a compromise in oxygen delivery. One porcine cardiac arrest study (3 minutes of untreated ventricular fibrillation, then 12 minutes of CPR) suggests that after 4 minutes of continuous chest compressions without rescue breathing, the delivery of 2 rescue breaths every 100 compressions provides a survival advantage over chest compressions alone."

The paradigm, again, is that hand-only CPR provides opportunity to get some help, other than no help at all, but the review also notes that more clinical data is needed on all fronts.

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  • $\begingroup$ I might add that not doing un-protected rescue breathing is being recommended as a way to prevent infection (same reason we wear disposable gloves when handling bodily fluids). $\endgroup$ – L.B. Mar 15 '15 at 17:34
  • $\begingroup$ Thanks for your response, but it doesn't answer the 2nd paragraph of my question, which is what I'm interested in knowing. $\endgroup$ – Daniel Mar 15 '15 at 18:07
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    $\begingroup$ I can get how "Stayin' Alive" will keep you in rhythm, but I am not sure if humming "Another One Bites The Dust" won't scare the daylights out of any bystander/helper who is not familiar with this exact recommendation. $\endgroup$ – skymningen Mar 16 '15 at 12:00
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    $\begingroup$ Sorry, i wasn't available to edit in more information due to some time constraints, but I've begun updating the answer to something acceptable. $\endgroup$ – CKM Mar 16 '15 at 20:03
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I will address your second paragraph. When you compress the chest, you are also compressing the lungs and some of the air in the lungs leaves. This air is them replaced when you come off the chest. And the lungs naturally reinflate. The mechanism alone in higher quality cpr helps circulate the blood and it is oxygenated with the air that is moving through the lungs from the compressions.

When I was working in the ER in Arizona, Tucson was one of the city's that did a pilot program using hands only cpr in it's ambulances. This was prior to making the changes in 2010 and the survival rates were much higher. Of course they did obtain an advanced airway when there were respiratory issues and once they arrived at the hospital. This allowed the second rescuer to start a line, place the patient on the monitor and AED etc.

Hope this helps!

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Some of the information contained in this post requires additional references. Please edit to add citations to reliable sources that support the assertions made here. Unsourced material may be disputed or deleted.

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    $\begingroup$ Welcome to Bio and thanks for your compelling answer. However, we urge users to add sources to their material such that others can background read on your material. $\endgroup$ – AliceD Apr 7 '17 at 6:53

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