What is the proper technique for hands-only cardiopulmonary resuscitation (CPR)?

Hands-Only CPR Technique

For untrained bystanders witnessing an adult cardiac arrest, hands-only CPR should be performed by pushing hard and fast in the center of the chest at a rate of 100-120 compressions per minute with a depth of at least 2 inches (5 cm). 1

Recognition and Initial Response

When encountering a potential cardiac arrest victim:

1. Check for responsiveness by tapping the victim's shoulder and shouting "Are you all right?"
2. Check for breathing - look for no breathing or only gasping
3. If unresponsive with no normal breathing:
   • Immediately activate emergency response system (call 911)
   • Begin chest compressions
   • Have someone get an AED if available 1

Proper Compression Technique

For effective hands-only CPR:

• Hand position: Place hands on the lower half of the sternum (breastbone) 1
• Compression rate: Push at a rate of 100-120 compressions per minute 1
• Compression depth: Push down at least 2 inches (5 cm) but avoid exceeding 2.4 inches (6 cm) 1
• Chest recoil: Allow complete chest wall recoil after each compression 1
• Minimize interruptions: Keep pauses in chest compressions as brief as possible 1

Who Should Perform Hands-Only CPR

The 2010 AHA Guidelines specifically recommend:

• Untrained lay rescuers should provide hands-only CPR with an emphasis on "push hard and fast" until an AED arrives or healthcare providers take over 1
• Trained lay rescuers who are confident in their ability can provide conventional CPR (30:2 compression-to-ventilation ratio), but hands-only CPR is also acceptable 1
• Healthcare providers should perform conventional CPR with compressions and rescue breaths 1

Effectiveness of Hands-Only CPR

Research has shown that hands-only CPR is as effective as conventional CPR for adult victims of witnessed cardiac arrest of cardiac origin 1. This simplified approach has several advantages:

• Eliminates barriers to action related to mouth-to-mouth contact
• Reduces time to first compression
• Simplifies training and retention of skills
• Increases bystander willingness to perform CPR 1

Common Pitfalls to Avoid

1. Inadequate compression depth: Many rescuers don't push hard enough. Remember to compress at least 2 inches deep 1
2. Improper hand position: Hands should be placed on the lower half of the sternum 1
3. Insufficient rate: Aim for 100-120 compressions per minute (slightly faster than once per second) 1
4. Leaning on the chest: This prevents full chest recoil and reduces effectiveness 1
5. Frequent interruptions: Minimize pauses in compressions 1

When to Use Conventional CPR Instead

While hands-only CPR is recommended for untrained bystanders witnessing adult cardiac arrest, conventional CPR (with rescue breaths) should be considered for:

• Children
• Drowning victims
• Drug overdose victims
• Victims of respiratory arrest
• Prolonged resuscitation efforts 1

By focusing on delivering high-quality chest compressions without interruption, bystanders can significantly improve survival outcomes for adult cardiac arrest victims until professional help arrives.