Compression-Only Cardiopulmonary Resuscitation (CPR)

CPR with rescue breathing and a barrier device is the recommended treatment for any victim of cardiac arrest when the rescuer is properly trained to perform CPR. However, a victim's blood contains enough oxygen to supply the vital organs for several minutes if the blood is adequately circulated during the event.
Therefore, "Compression-Only" CPR is an acceptable alternative to the traditional procedure and could potentially save-lives in some cases.

The air we breathe contains more oxygen than our body requires at one-time. When sudden cardiac arrest occurs, a victim's bloodstream and lungs are normally saturated with oxygen. Therefore, a victims circulating blood volume has some oxygen content regardless of where it is in the circulatory system as long as the rescuer reaches the victim within the first minute or two following the collapse. The extra-oxygen in their lungs and blood stream makes Compression-only CPR possible and potentially helpful for short periods of time, especially when the arrest was witnessed and chest compressions are initiated rapidly.

Remember: Check the scene for hazards First, the victim Second!

If a victim is found to be unresponsive to loud verbal stimuli such as shaking their shoulder and asking them if their ok, immediately call for Help (911).

Then...

Ensure your own Personal Safety:

Always combining Universal Precautions with the appropriate
Personal Protective Gear before initiating first aid and/or CPR on ANYONE!

The minimal universal precaution requirement for conducting compression-only CPR on any person of any age consists of protective gloves.

According to the National Standards for CPR, compression-only CPR continues to be an acceptable alternative to full CPR, especially if the rescuer isn't properly trained or is unwilling/unable to perform rescue breathing.

Hands-only CPR can be highly-effective in the right circumstance. But it should be noted that "hands-only" CPR is not fully recommended for the treatment of infants and small children, drowning victims, and victims that collapse from a known breathing problem such as carbon monoxide poisoning. The younger the victim the more they will benefit from the rescue-breathing portion of the procedure.

However,

Hands-only CPR is now considered appropriate for infants and children when the only person available to render care is not trained in rescue breathing. It is appropriate because, it is believed that someone not properly trained to deliver rescue-breathing would inadvertently delay the circulation of oxygen that may remain in the victim's blood stream by attempting to deliver rescue-breathing instead of delivering high quality "fast-n-hard" chest compressions or they won't initiate care on the child/infant because they feel they may be "doing it incorrectly". Basically, the belief centers around the saying, "something is better than nothing." Circulating the victim's blood with high-quality "fast-n-hard" chest compressions offers a better chance of survival than awaiting help to arrive. High quality, "fast-n-hard" chest compressions should be initiated as quickly as a cardiac arrest is evident and continued without un-needed delay until an AED or EMS arrives to take over care of the victim. Recent evidence has shown it to be a highly effective alternative to full-CPR, especially in adults and when the arrests are witnessed.

Hands-Only/Compression-Only CPR

After the victim is determined to be unresponsive/breathless and 911 has been called:

• 1. Don protective exam gloves, if available. Conducting "hands-only" CPR on a victim that has dry intact skin is not likely to place the rescuer in much danger of contacting a communicable disease. However, it is highly recommended to protect yourself with at least latex exam gloves when conducting CPR on anyone! Be very cautious and avoid coming in contact with any type of the victim's body fluid. If it's wet-avoid it!
• 2. Quickly position the unresponsive victim on their back on a solid surface that won't give when compressions are administered (not a bed or sofa).
• 3. Position your body on either side of the victim in the area of their upper chest and expose their sternum area.
• 4. Next, locate the proper hand position by placing the heel of one hand on the center of the victim's sternum (breastbone). The heel of your hand will be on the imaginary straight line between their nipples.
  Note: It is common to use the heel of your prominent hand on the chest If you feel the little indentation or "notch" (xiphoid process) at the bottom of the victim's sternum, you're too low and need to move your hand up about 2 finger widths. This should place the heel of your hand in the center of their sternum. Place your other hand directly over the first and interlace your fingers.
  Note: Try to keep your fingertips off the chest by interlacing them or holding them upward.
  
• 5. Position your body so that your shoulders are directly above your hands and the victim's chest. Keep your arms as straight as possible to prevent early rescuer fatigue and to ensure powerful compressions. This position helps you to deliver smooth straight-down compressions consistently.
  
• 6. Deliver "fast-n-hard" chest compressions at a rate of 100 to 120 per minute for all victims regardless of age (new rule as of Oct, 2015). A counting method such as 'one and two and three and four and five,' and so on, helps you keep a smooth and steady rhythm. Note: The terms, "fast-n-hard" refers to the new adult chest compression rate and depth recommendations. Chest compressions that are delivered to slow (less then 100 pr minute) will not effectively deliver blood to the vital organs and tissues of the body. Compressions delivered to fast (above 120 pr minute) will not allow the heart to fill with enough blood, again decreasing the amount of blood that reaches the vital organs. The proper depth of compressions for an adult is between 2 and 2.4 inches (5 to 6 cm). Compressions that are too shallow will not effectively pump oxygenated blood throughout the body. The upper limit has been added because compressions administered too deep are ineffective and can cause significant rib fractures or damage to the heart.
  
• 7. Allow the chest to fully recoil before initiating another compression. This allows the chambers of the heart to re-fill with blood before being "pumped out" by the next compression. However, do not remove your hands from their chest between compressions. This practice keeps the rescuers hands in the proper position and allows them to feel when the chest fully recoils.
• 8. Continue delivering chest compressions at a rate of 100 to 120 per minute until an AED and/or EMS arrive to take over care of the victim.

Note: Chest compressions should only be stopped when:

• The victim shows obvious signs of life such as breathing/moving
• EMS arrives to take over care of the victim
• An AED is attached and prepared to analyze/shock the victim
• The scene becomes too unsafe to continue
• Total exhaustion prevents continuing care

If the victim begins to breathe on his/her own, it is appropriate to place them in the recovery position until help arrives. However, if a spinal injury is suspected, make sure to use the HAINES version of this position discussed in greater detail in the recovery position section of the training material.

Let's Review Hands-only CPR:

First:

Check the scene and make sure it's safe for you to proceed. Don't become a victim yourself!

Then:

C - Check the victim's level of consciousness. Tap them on the shoulder and ask loudly, "are you okay"? (Remember: it is no longer recommended to "Look, Listen, and Feel" for a pulse or signs of life if you are not a healthcare professional; only assess for responsiveness/breathing.)

P - Phone for Help or ask one-specific person near-by to call 911 for you so you can begin care on the victim.

R - React by initiating life-saving interventions including "hands-only" CPR until an AED or EMS arrives to take over care of the victim.

CPR Guideline Update

Important Points to Hands-Only CPR:

• Always be aware of your surroundings and do not enter an unsafe scene to render care.
• Protect yourself with at least exam gloves, at least.
• Deliver continuous high quality "fast-n-hard" chest compressions without delay as soon as it is determined the victim isn't responsive/breathing.
• Chest compressions should be delivered 2-to-2.4-inches in the center of the victim's chest for adults.
• Chest compressions should be delivered in the center of the chest to a depth of 2-to-2.4-inches for adults, 1.5-to-2-inches for children, or 1.5 inches for infants.
• Compressions should be administered at 100-to-120-per minute continuously for all victims of cardiac arrest.

Continue "fast-n-hard" chest compressions until:

• The victim shows signs of life such as spontaneously breathing/moving
• An AED is prepared to analyze/shock the victim or EMS arrives to take over care and asks you to stop
• Someone trained in CPR with rescue-breathing arrives to help
• The scene becomes too unsafe to continue the resuscitation effort

Congratulations!

You have completed the Compression-Only material. If you are comfortable with the presented material, feel free to continue to the Recovery Position section.