Hands-Only CPR: When and How to Perform Compression-Only Resuscitation

Hands-Only CPR (compression-only cardiopulmonary resuscitation) is a simplified, evidence-based approach for lay rescuers witnessing sudden cardiac arrest in adolescents and adults.

When to Use Hands-Only CPR

• Witnessed sudden collapse of teen/adult
• Rescuer untrained or unwilling to perform rescue breaths
• Out-of-hospital cardiac arrest (OHCA) with likely cardiac cause
• Not for: Unwitnessed arrest, drowning, drug overdose, children/infants, respiratory arrest — these need conventional CPR with breaths

How to Perform Hands-Only CPR

1. Check responsiveness: Tap and shout "Are you OK?"
2. Call 911 (or send someone); get AED if available
3. Position: Kneel beside victim on firm, flat surface
4. Hand placement: Heel of one hand on center of chest (lower half of sternum); other hand on top, fingers interlaced
5. Compressions:
   • Push hard and fast: ≥2 inches (5 cm) depth
   • Rate: 100-120 compressions/minute
   • Allow full chest recoil
   • Minimize interruptions
6. Continue until: AED arrives, EMS takes over, victim moves/breathes normally, or rescuer exhausted

Why It Works

• Circulates oxygen already in blood (sufficient for first few minutes)
• Eliminates hesitation from mouth-to-mouth reluctance
• Simpler to learn, remember, and perform
• Dispatcher-assisted: 911 operators can guide in real-time

Evidence Base

• 2010 AHA Guidelines: Hands-Only CPR recommended for untrained lay rescuers
• SOS-KANTO, Japanese registry: Similar survival for compression-only vs. conventional CPR in adult OHCA
• Meta-analyses: No survival difference for cardiac etiology; conventional CPR better for non-cardiac

Key Differences from Conventional CPR

Public Action

• Learn Hands-Only CPR (2-minute video at heart.org/handsonlycpr)
• Download PulsePoint app (alerts nearby CPR-trained citizens)
• Advocate for AED placement in public spaces
• Support CPR training in schools

Any attempt at CPR is better than none. Push hard, push fast, don't stop. You can save a life.

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Hands-Only CPR	Conventional CPR
Compressions only (no breaths)	30 compressions : 2 breaths
Lay rescuers, witnessed adult arrest	Trained rescuers; all ages/etiologies
No mouth-to-mouth barrier needed	Barrier device recommended
Easier to teach/perform	More skills required