What is the success rate of hands-only Cardiopulmonary Resuscitation (CPR)?

Hands-Only CPR Success Rate

Hands-only CPR demonstrates survival rates of 4-15% for out-of-hospital cardiac arrests, which is comparable to or slightly better than conventional CPR with rescue breathing in adults with witnessed cardiac arrest of presumed cardiac origin. 1

Effectiveness of Hands-Only CPR vs. Conventional CPR

Adult Cardiac Arrest Outcomes

• Survival to hospital discharge with hands-only CPR: 4-15% 1
• Neurologically favorable 1-month survival: 6% with hands-only CPR vs. 4% with conventional CPR 1
• Neurologically favorable 1-year survival: 4% with hands-only CPR vs. 4% with conventional CPR 1

The 2019 international consensus guidelines show that dispatcher-assisted CPR (which often involves hands-only technique for untrained rescuers) is associated with:

• 9 more survivors with favorable neurological outcomes per 1000 patients
• 14 more survivors per 1000 patients at hospital discharge
• 27 more patients achieving return of spontaneous circulation (ROSC) per 1000 patients 1

Key Advantages of Hands-Only CPR

1. Faster initiation: Untrained bystanders start hands-only CPR more quickly than conventional CPR
2. Fewer interruptions: Hands-only CPR results in fewer pauses in chest compressions
3. Simpler technique: Less cognitive burden makes it easier for untrained rescuers to perform
4. Better retention: Skills decay less over time (18 months) compared to conventional CPR 1

Factors Affecting CPR Success

Critical Determinants of Survival

• Time to CPR initiation: Every minute delay decreases survival by 7-10%
• Quality of compressions: Proper depth and rate significantly impact outcomes
• Duration of CPR: Longer CPR duration correlates with decreased survival (1-minute increment associated with 1.2-fold decrease in achieving ROSC) 2
• Initial cardiac rhythm: Shockable rhythms (VF/VT) have better outcomes than asystole or PEA
• Cause of arrest: Cardiac etiology has better outcomes than non-cardiac causes 2

Population Differences

• Adult outcomes: Overall 6-8% survival for out-of-hospital cardiac arrest 1
• Pediatric outcomes:
  • Out-of-hospital: 3.3% for infants, 9.1% for children, 8.9% for adolescents 1
  • In-hospital: Significantly better at 33-43% overall 1

Important Clinical Considerations

When Hands-Only CPR Is Most Effective

• Adult victims of witnessed sudden collapse
• Presumed cardiac etiology
• First few minutes after collapse (before blood oxygen levels deplete)

When Conventional CPR (with rescue breathing) Is Preferred

• Children and infants (respiratory causes more common)
• Drowning victims
• Drug overdose-related arrests
• Prolonged down time before CPR initiation

Common Pitfalls to Avoid

1. Inadequate compression depth: Ensure 2-2.4 inches depth in adults
2. Improper hand position: Center of chest at nipple line
3. Slow compression rate: Maintain 100-120 compressions per minute
4. Incomplete chest recoil: Allow full chest recoil between compressions
5. Excessive interruptions: Minimize pauses in compressions

Practical Implications

For witnessed adult cardiac arrest of presumed cardiac origin, hands-only CPR provides similar or slightly better outcomes compared to conventional CPR when performed by bystanders. The simplified technique increases the likelihood of bystander action and maintains adequate perfusion during the critical first minutes after collapse.

The evidence strongly supports promoting hands-only CPR training for the general public, as it removes barriers to action and can significantly improve survival rates when performed promptly and effectively.