Doubling the survival rate: Hands-only CPR gaining awareness
Health care professionals hope a lesser known technique for cardiopulmonary resuscitation or CPR will encourage more laypeople to get involved in helping to save a life when an emergency strikes.

Hands-only CPR removes the need for a person to place their mouth on that of the person they are trying to help. It was actually around before the COVID-19 pandemic, so that is not the reason this came into being.

"This may be one of the most important medical stories to tell," said Eric Jaeger, EMS educator and paramedic at Exeter Hospital. "If someone goes into cardiac arrest or is found unconscious, it is vital to start CPR. The hands-only method eliminates the need for a person to do rescue breathing as part of the process."

Jaeger said some people are hesitant to start CPR because of the perceived need to do rescue breathing.
"They feel they are not trained enough, or they are just uncomfortable putting their mouth on another person, particularly if it is a stranger. Although we will start giving oxygen when we arrive, we have recognized that for the layperson, rescue breathing is not the vital part."

Emily Knight, RN, CPAN, training center coordinator/PALS faculty at Wentworth-Douglass Hospital, has a 20-year association with the American Heart Association, serving on the New Hampshire Board of Directors, and bringing community advocacy to New Hampshire, Vermont and Maine.

Knight said an average of 350,000 cardiac arrests occur out of a hospital, with 70% or higher happening in homes. She said when medical professionals learned that there is small amount of ventilation that happens during compressions, it was a no-brainer.

"Hands-only CPR doubles the survival rate of doing nothing," she said. "So think, half of that 350,000 a year can be helped as you wait the arrival of the ambulance."

 "Hands-only CPR has been around for 5 to 7 years," said Knight. "For whatever reason, it is quiet in some areas although there are pockets of the country where it is very actively used and the use has been encouraged. It is widely used in the Midwest and California. Airports have kiosks on this."

Knight said she thinks hands-only CPR gives lay people a better feeling of being in control of the situation.

The vital part is chest compressions, which Jaeger said everyone can do effectively.

"We have learned chest compressions give both positive and negative ventilation and perfusion together," said Knight. "It can increase chances of survival until the person can receive medical help. The exception is for children under one year, where we still recommend rescue breaths. For young children. we recommend mouth to mouth, because kids need more respiratory support than an adult does."

"The goal is 100 to 120 beats per minute," said Jaeger. "We say do it to the beat of the song 'Stayin Alive' by the Bee Gees. If you watched 'The Office,' they did a good, yet funny demonstration of this." You can watch the scene of the show on YouTube at https://www.youtube.com/watch?v=Vmb1tqYqyII

If it seems like someone needs CPR, Jaeger said to begin and have someone else call 911.

Knight said calling 911 will give the caller a person trained to walk people through CPR. She said 911 operators have a registry of AEDs (automated external defibrillators) and can advise where the nearest one to the patient is located. CPR should always be done on a hard surface, not a soft bed.

"If they don't need it, they will likely wake up and tell you to stop," Jaeger said. "This comes up, particularly in substance use cases. A family member will start CPR, as they have been trained to. By the time we arrive, the person is sitting up, rubbing their chest."

It is a misconception that CPR keeps people alive. Jaeger said it actually prolongs oxygen getting to the heart until help arrives.

There are a few guideline changes because of COVID-19. Knight said the rescue person should place a towel over the victim's face, to protect them from aerosol emissions. She said if PPE is available, use it.

"Go in and do the best you can," Knight said. "Keep doing it until help arrives, until someone can relieve you, or until you just can't do it any longer."

"It's a deceptively straight-forward story," Jaeger said. "But, if two people read this story, they might save a life."

"Hands-only CPR is easy to learn, with classes offered by the American Red Cross and other agencies," said Knight. "If you go to CPR.heart.org, there is a tutorial."

The American Heart Association also has a video demonstration of hands-only CPR, at https://www.youtube.com/watch?v=M4ACYp75mjU