Update on My Hands-Only CPR Post: The AHA’s Response | The Survival Doctorby James Hubbard, MD, MPH

If you read my post about Hands-Only CPR Monday, you know that I believe the American Heart Association’s guidelines leave room for interpretation. So my team emailed them to see if they could officially clarify some points.

Here’s part of their response. It addresses some issues related to Hands-Only CPR, a trademarked term for doing chest compressions only (no mouth-to-mouth), but doesn’t clarify completely.

First, the AHA explained the rationale for not doing respirations (mouth-to-mouth) in most teens and adults:

… when a teen or adult suddenly collapses with cardiac arrest, his or her lungs and blood contain enough oxygen to keep vital organs healthy for the first few minutes, as long as someone provides high-quality chest compressions with minimal interruption to pump blood to the heart and brain. This is the rationale for Hands-Only CPR for these folks.

Then, the AHA answered our question about bullet point three in their guidelines. That point says respirations are still recommended for “anyone found already unconscious and not breathing normally.” I assumed this referred to people who are exhibiting agonal breathing (which, as I explained in my post, is not technically breathing), not people who are, for example, on drugs or alcohol and have labored breathing. The AHA responded:

If someone is found already unconscious and not breathing (or not breathing normally), we do not know how long that person has been in cardiac arrest—we therefore recommend providing breaths in this case. So the 3rd bullet point MAY include victims who exhibit agonal breathing or not breathing at all. Infants, children, and other victims whose cardiac arrest may be precipitated by respiratory conditions, as listed in bullet point #4 will all benefit from conventional CPR with breaths.

When we asked the AHA to clarify whether “not breathing normally” means agonal breathing, they responded:

To the lay person they are the same thing so we do not specify.

Any victims of drowning, drug overdose, collapse due to breathing problems, or prolonged cardiac arrest should receive conventional CPR with breaths.

CPR masks

For times when you do need to perform respirations, you can buy masks to protect yourself. Options like these attach to your key chain. (Amazon affiliate link.)

So I go back to the conclusion in my post: In a survival situation, we have to make some assumptions about what these guidelines mean and how to apply them.

No matter what, as I’ve said before, it’s rare for CPR alone to revive people, so if it’s needed, that’s a time to try your best to get professional help if at all possible. And don’t forget to have someone look for an AED if you’re in a public area.

You can now get video-based training on CPR and other life-saving techniques directly from me in The Survival Doctor’s Emergencies Training Course. Now enrolling.