Hands-only resuscitation replaces mouth-to-mouth

It's a disturbing fact that only a third of adults who collapse from cardiac arrest get the emergency first aid that can help them survive. Cardiopulmonary resuscitation (CPR) usually involves giving a person mouth-to-mouth while pressing hard on the center of the chest. The procedure, which can be performed by any adult, is intended to maintain a flow of blood and oxygen to the heart and brain until emergency medical help arrives, and it doubles someone's chances of surviving. Yet bystanders are often worried about making things worse, and many people don't like the idea of giving mouth-to-mouth.

Now, a round-up of the research on cardiac arrests, published by the American Heart Association (AHA), says that, in many cases, using chest compressions alone (called "hands-only CPR") is likely to work just as well as traditional CPR using mouth-to-mouth. And bystanders may also find it easier to carry out.

According to the AHA, anyone who sees an adult suddenly collapse should:

• Call 911
• Push hard and fast on the center of the person's chest.

The AHA points out that an adult who collapses and isn't responding is very sick, so there's very little chance of making things worse. It's fairly common to break a rib while doing CPR, but without urgent help, a person in cardiac arrest is almost certain to die.

You need to continue with CPR until emergency services arrive. Chest compressions are hard work, so if there's someone around who can help, swap over as you get tired. If you're on your own, just do the best you can.

There are still some instances where traditional CPR, including mouth-to-mouth, is better. Adults who are found already unconscious, children, victims of drowning or people with breathing problems may be better off getting traditional CPR. If you've been taught how to give mouth-to-mouth resuscitation, and are confident you can do it, you can still do CPR in the way you were trained. But any attempt at CPR is better than nothing.

If you see someone collapse, call 911, then start pushing hard and fast on the center of the person's chest. If you've been trained in CPR that includes mouth-to-mouth, and you're confident you can do it, add 2 breaths for every 30 chest compressions.

—Philip Wilson, patient editor, BMJ Group

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