Hands-Only CPR

The AHA has issued a new Hands-Only (Compression Only) CPR advisory. The advisory applies to bystanders, not professional rescuers.

When you see an adult suddenly collapse, use Hands-Only CPR: that’s CPR without mouth-to-mouth breaths. And it can help save lives.

Hands-Only CPR is CPR without mouth-to-mouth breaths. It is recommended for use by bystanders who see an adult suddenly collapse in the “out-of-hospital” setting. It consists of two steps:

Call 911 (or send someone to do that).
Begin providing high-quality chest compressions by pushing hard and fast in the center of the
chest with minimal interruptions
The American Heart Association recommends conventional CPR (that is, CPR with a combination of breaths and compressions) for all infants and children, for adult victims who are found already unconscious and not breathing normally, and for any victims of drowning or collapse due to breathing problems.

AHA Hands-Only Advisory


I’ve posted these strips before. It is an ETCO2 readout while the patient has just been intubated during CPR, but before the ambu-bag has been attached and ventilation begun. (I always attach the capnofilter to my ET tube before I intubate.) The tiny bumps are CPR, each compression creates a small tidal volume that releases CO2, ventilating the body by compression only. The large wave is from the first ambu-bag ventilation on the just placed ET tube.


Based on a code I did yesterday at a nursing home, I would add some nursing home workers to the bystander category. Even with multiple hands and an ambubag, it is rare to see ventilations done properly, and even when they are done well, they are often at the expense of good compressions.


  • Rogue Medic says:

    If you attach the capnography to the Ambubag (instead of the ETT), you can have a baseline waveform to compare when the tube is in and the device will have already started to give readings. It sometimes seems to take a bit for the capnography to “warm up.”Eventually, we will probably increase the number of compressions vs ventilations for health care providers. The research does not support being aggressive with ventilations in cardiac arrest. Not ventilating does not feel right, but I don’t think that the research is misleading us. We just do not understand the way CPR works as well as we thought we did.

  • PC says:

    I tried this, but found I needed an adaptor that we don’t have.See: http://medicscribe.blogspot.com/2008/01/etco2-with-bvm.html

  • Rogue Medic says:

    If the Ambubag connects to the mask in the same way that it connects to the endotracheal tube, and the air exchange is the same as with an endotracheal tube, then the capnography attachment should work the same way without any adapter. I haven’t worked with LP 12s for several years. I believe that I was able to do this without any problems when I did work with LP12s.

  • Rogue Medic says:

    Sorry, brain flatulence. The Ambubag attaches to the outside of the ETT, but the inside of the mask, so there would need to be an adapter. I don’t know if we had one or Rube Goldberged it.

  • Anonymous says:

    Fire always bags my patients at a rate of between 30-45 breaths per minute. I need to remind them constantly, don’t bag. Don’t bag. Don’t bag. Now I just slap a non rebreather on them. Better outcomes, no gastric distention.

  • PC says:

    Thanks for the comments. I was at a meeting today and I had promising research discussed from an area that just does compressions and epi and holds off intubation into deep into the code. I’ll try to get more info.

  • Rogue Medic says:

    I’m not a fan of epinephrine in cardiac arrest. The 2005 guidelines take the priority away from the drugs. “There is inadequate evidence to identify an optimal number of CPR cycles and defibrillation shocks that should be given before pharmacologic therapy is initiated. The recommended sequence depicted in the algorithm is based on expert consensus. If VF/VT persists after delivery of 1 or 2 shocks plus CPR, give a vasopressor”.Performing good, continuous compressions until ready to defibrillate, defibrillating (if indicated) then immediately resuming compressions seems to be what is the best thing to improve long term outcomes.Getting a pulse back quickly, only to lose the patient later on, is not acting in the best interests of the patient.When there is research to show otherwise, I will re-evaluate my position. So far, the ALS only seems to interfere with the delivery of good BLS – the stuff that has been shown by research to make a difference in long term survival.

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