DAN News
Hands-Only CPR Statement from DAN Education
Last Updated: 7/29/2010 4:53:36 PM

The American Heart Association recently released a position statement, intended to clarify cardiopulmonary resuscitation (CPR) training for lay rescuers, regarding the use of compression-only CPR without delivering rescue breaths. This statement was issued to “amend and clarify the “2005 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC)” for bystanders who witness an adult out-of-hospital sudden cardiac arrest.”

Extensive research, completed since the 2005 guidelines were released, indicates the survival rates for full CPR are no better, and no worse, than compressions-only CPR. These studies discuss only the situation where a collapse was witnessed and only pertains to adults in non-choking and non-drowning scenarios.

The idea is that if the perceived barrier of delivering rescue breaths as part of CPR is removed, bystanders will be more likely to administer care to a collapsed adult: “Although bystander CPR can more than double survival from cardiac arrest, the reported prevalence of bystander CPR remains low in most cities, about 27% to 33%. Reducing barriers to bystander action can be expected to substantially improve cardiac arrest survival rates.”

While this change is important with regards to lay rescuers providing emergency care in the event of a collapse on the street, it will not affect the care of an unconscious diver. Loss of consciousness with cardiac arrest in water must always be assumed to include elements of drowning. For this reason, full CPR is still recommended. Therefore, DAN Education does not plan to change any DAN courses to feature Hands-Only^TM CPR. For the most part, the proposed changes do not translate to the diving environment.

The AHA ECC Committee admits this in their statement: “The AHA ECC Committee acknowledges that all victims of cardiac arrest will benefit from delivery of high-quality chest compressions (compressions of adequate rate and depth with minimal interruptions) but that some cardiac arrest victims (e.g., pediatric victims and victims of drowning, trauma, airway obstruction, acute respiratory diseases, and apnea [such as that associated with drug overdose]) may benefit from additional interventions taught in a conventional CPR course. Therefore, the Committee continues to encourage the public to obtain training in CPR to learn the psychomotor skills required to care for a wide range of cardiovascular- and respiratory-related medical emergencies.”

DAN Instructors teaching DAN classes will need to be aware of this change in emphasis, however. As basic-level CPR classes change, students may no longer know how to perform rescue breathing, depending on their level of experience and training. This will require additional training and practice to develop proficiency at the DAN level.

The following are the recommendations from the AHA:
All victims of cardiac arrest should receive, at a minimum, high-quality chest compressions (i.e., chest compressions of adequate rate and depth with minimal interruptions). To support that goal and save more lives, the AHA ECC Committee recommends the following:

• When an adult suddenly collapses, trained or untrained bystanders should — at a minimum — activate their community emergency medical response system (e.g., call 911) and provide high-quality chest compressions by pushing hard and fast in the center of the chest, minimizing interruptions (Class I).
• If a bystander is not trained in CPR, then the bystander should provide Hands-Only CPR (Class IIa). The rescuer should continue Hands-Only CPR until an automated external defibrillator arrives and is ready for use or EMS providers take over care of the victim.
• If a bystander was previously trained in CPR and is confident in his or her ability to provide rescue breaths with minimal interruptions in chest compressions, then the bystander should provide either conventional CPR using a 30:2 compression-to-ventilation ratio (Class IIa) or Hands-Only CPR (Class IIa). The rescuer should continue CPR until an automated external defibrillator arrives and is ready for use or EMS providers take over care of the victim.
• If the bystander was previously trained in CPR but is not confident in his or her ability to provide conventional CPR including high-quality chest compressions (i.e., compressions of adequate rate and depth with minimal interruptions) with rescue breaths, then the bystander should give Hands-Only CPR (Class IIa). The rescuer should continue Hands-Only CPR until an automated external defibrillator arrives and is ready for use or EMS providers take over the care of the victim.

If you have any questions about this subject and teaching your DAN courses, call us at +1-919-684-2948 or send an email to oxygen@diversalertnetwork.org.