It’s terrible to even imagine, but what would you do if you saw someone suddenly collapse and stop breathing? Chances are the person has experienced cardiac arrest, an electrical malfunction that causes the heart to beat rapidly and chaotically — or to stop beating altogether.

After calling 911, you should begin hands-only cardiopulmonary resuscitation (CPR), which does not involve the mouth-to-mouth breathing used in standard CPR. For more than a decade, national guidelines have recommended the simpler, hands-only version of CPR for cardiac arrests that occur outside a hospital.

Now, a large Swedish study confirms that just like standard CPR, hands-only CPR doubles a person’s odds of surviving at least 30 days after cardiac arrest. Researchers analyzed data from more than 30,000 cases of out-of-hospital cardiac arrest from 2000 to 2017, when hands-only CPR was gradually adopted into Sweden’s CPR guidelines. Hands-only CPR use rose sixfold over the course of the study.

Overcoming barriers

“We need to do a better job encouraging people to perform bystander CPR, and learning this simpler version seems to help,” says Dr. Charles Pozner, associate professor of emergency medicine at Harvard-affiliated Brigham and Women’s Hospital. Hands-only CPR eliminates the fear of communicable diseases, one of the main reasons people say they’d hesitate to perform CPR.

Another barrier people cite is fear of injuring the person — especially by doing compressions incorrectly or on someone who doesn’t actually require CPR. “It’s true that even correctly done CPR can crack a person’s ribs,” says Dr. Pozner. But it’s better to perform chest compressions on somebody who doesn’t need them than to withhold compressions for someone that does, he adds.

To be clear, CPR does not restart a person’s heart, but it’s a crucial step in the chain of survival. CPR keeps blood circulating until the person’s heart can be shocked back into a normal rhythm with an automated external defibrillator (AED). Although emergency personnel will bring and use this device, bystanders must be trained to obtain and use public access AEDs if we want to have the most favorable outcomes, Dr. Pozner says.

Basic hands-only CPR instructions

The other reason people hesitate to perform CPR is that they don’t know how. The American Heart Association (AHA), American Red Cross, and other organizations offer classes in CPR and the use of a public access defibrillator.

Here are the basic steps to follow after calling 911 (and if your put your phone on speaker, the operator can talk you through the steps):

  1. Place the person on the floor.
  2. Kneel beside the person.
  3. Place the heel of one hand on the center of the person’s chest. Place the heel of the other hand on top of the first hand and lace your fingers together.
  4. Position your body so that your shoulders are directly over your hands. Keeping your arms straight, push down with your arms and hands, using your body weight to compress the person’s chest.
  5. Push hard enough to press the chest down at least two inches.
  6. Continue pressing the chest at a rate of 100 to 120 compressions per minute. This rhythm corresponds to the beat of two (appropriately titled) songs popular in the late 1970s, “Stayin’ Alive” and “I Will Survive.” (New York-Presbyterian Hospital created a curated list of more recent songs, as well as some older ones, with similar beats; see nyp.org/cpr.)
  7. Continue hands-only CPR until emergency medical service (EMS) personnel arrive. If possible, enlist another person to take over for you after a few minutes, because doing the compressions can be tiring.


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