Part I of our series discussed the recognition of cardiac arrest and getting help. We’ll now discuss bystander initiated CPR, the obstacles that prevent CPR from being started immediately, and this will lead us into Part III – Public Access Defibrillation which will discuss use of an automated external defibrillator (AED).

Hands Only CPR

When cardiac arrest occurs in the public setting, it should be assumed that bystanders will not be carrying pocket masks and breathing barriers on their person. Keychain pocket masks provide convenient barriers to safely deliver rescue breaths in the public setting. Bystanders and healthcare providers are not expected to provide mouth to mouth resuscitation.

Q. What do you do when you come upon a cardiac arrest victim with no way to safely deliver rescue breaths?

A. Hands Only CPR. Hands only CPR provides lifesaving compressions to victims of a cardiac arrest victim when no breathing barrier is available. A bystander that finds a person who is not responsive and is not breathing normally should call 911, request an AED, and begin chest compressions.

Is the person responsive? NO

Is the person breathing normally? NO

We are going to start CPR. GO

The first two actions of calling 911 and retrieving an AED should be delegated to another bystander if someone else is nearby. Be sure to specify the bystander(s) that will complete these actions. If you’re alone, call 911 and retrieve the AED first before providing care.

To provide hands-only CPR, remove clothing to bare the person’s chest.

Interlock your fingers and place the heel of your hand on the lower half of the breastbone, in-line with the nipples.

Lock your elbows and use your body weight to compress the chest about two inches. Repeat at a rate of 100 compressions per minute (the same tempo as Staying Alive by the Bee Gees or your choice of another approved CPR song).

If other bystanders are available, rotate rescuers every two minutes or approximately 200 compressions.

Continue providing hands-only CPR until trained help arrives and takes over. If the person begins to breathe normally or have meaningful movement, stop chest compressions and watch them until help arrives. Be prepared to start chest compressions again if they stop breathing normally.

Check out this fun video from the American Heart Association which shows the steps of hands-only CPR.

Here are the important notes to remember for providing high-quality hands only CPR:

PUSH HARD: Compress the chest two inches. Allow full chest recoil – there should be no pressure on the chest between each compression.

PUSH FAST: Compress the chest at a rate of 100 compressions per minute. Avoid pushing too fast (over 120 compressions per minute).

MINIMIZE INTERRUPTIONS: Gaps in chest compressions kill cardiac arrest victims. Avoid any interruptions in CPR. Communicate when you’re switching rescuers so the next rescuer can restart compressions without missing a beat. The rescuer using the AED can also apply the pads while the rescuer is providing chest compressions.

Overcoming Obstacles for Bystander Initiated CPR

The Cardiac Arrest Registry to Enhance Survival (CARES) collects data on cardiac arrest victims provided by 1,400 EMS providers and 1,900 hospitals nationwide. This collaboration provides a snapshot of cardiac arrest incidence, implementation of chain of survival steps, and patient outcomes. The reports can provide a comparison for how a particular community, state, or region performs in these metrics.

The most pertinent metrics to consider when evaluating the frequency of bystander initiated CPR include whether or not the cardiac arrest was witnessed and whether or not bystanders initiated CPR before EMS arrived.

In 2017, approximately 49% of cardiac arrests reported to CARES were witnessed. Of these arrests, approximately

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