All hands - - only hands - - on deck

Chicago Sun-Times: October 13, 2010

http://www.suntimes.com/lifestyles/mindbody/2794946,FIT-News-FAid13a.article

All hands -- only hands -- on deck
AHA recommends chest compressions without mouth-to-mouth

By Carol Slezak

Imagine that you have watched someone collapse, and you want to administer CPR. Should you perform chest compression alone, or chest compression plus mouth-to-mouth resuscitation?

This topic has generated a fair amount of debate in recent years. The American Heart Association, which will release new CPR guidelines Monday, addressed it in a 2008 advisory statement, indicating that chest compression, also called hands-only CPR, was on par with chest compression plus mouth-to-mouth. The new guidelines will reinforce this position.

"Hands-only CPR is basically what the AHA teaches now," said Dr. Stephen Archer, chief of cardiology at the University of Chicago Medical Center and president of the AHA's Metro Chicago board of directors.

The AHA sums up its position on its website (americanheart.org):
When an adult suddenly collapses, trained or untrained bystanders should:
1. Call 911
2. Push hard and fast in the center of the chest

There are two primary reasons for the change: First, the AHA believes that CPR is more likely to be performed if hands-only is an option, because people don't like performing mouth-to-mouth on strangers. Second, multiple studies, including one published last week in the Journal of the American Medical Association, have shown hands-only CPR to be equally or more effective than compression plus mouth-to-mouth.

"Why is hands-only more effective?" Archer said. "It could be because when you stop pressing on the chest to give mouth-to-mouth, you actually stop pressing a lot longer than you would expect. And chest compression is more important [than getting oxygen into the lungs]. You have to keep the blood flowing to the brain. It's the relative value of oxygen to the lungs versus the relative value of keeping the blood moving."
Archer noted that the hands-only guidelines are meant for adults.

"When children need resuscitation, it often is respiratory -- drowning or swallowing," he said. "For children, rescue breathing [mouth-to-mouth] can have some value."

Not everyone has completely embraced the hands-only guidelines. The American Red Cross, for instance, believes that oxygen is an important component of CPR. But the Red Cross recognizes that hands-only CPR has its place.

"We lean toward the fact that you need to put oxygen into your system to help keep your body and organs alive," said Theresa Rees, manager of instruction and development for the Red Cross of Greater Chicago. "However, if you have never been trained to do this, hands-only CPR is better than nothing."

The AHA cautions that CPR is not intended to take the place of professional medical care.

"It's an important breakthrough," Archer said. "But it's important to note that this does not mean that paramedics, etc., would stop delivering advanced cardiac life support. This is for when you come across someone who is down on the ground. This is what we teach. If you see a person fall, call 911 and push hard and fast in the middle of the chest."