If a stranger passed out on the sidewalk in front of you, how likely would you be to administer mouth-to-mouth?

In our age of no-touch faucets in public bathrooms and special disinfectant wipes for grocery store carts, you wouldn’t be alone if you say you might hesitate.

Happily, two new studies conclude that when it comes to CPR, pressing rhythmically on the chest with your hands is enough to save a life.

No mouth-to-mouth required.

The American Heart Association, which has been promoting hands-only CPR for two years, hopes that bystanders will feel less apprehensive and more likely to act if faced with an emergency.

Studies indicate that fear of doing something wrong, more so than catching something, makes many would-be-heroes freeze. And people may have has good reason to fear doing something wrong when practicing traditional mouth-to-mouth CPR.

The traditional method is a bit complicated, and one study showed that those who did attempt it often didn’t do it very well. For starters, the victim’s head has to be tilted back, the airway cleared, the nose pinched and the mouth completely covered with the rescuer’s.

There are many opportunities for air to escape, and some experts believe that some bystanders perform mouth-to-mouth so poorly that the interruption reduces blood flow.

Yet the aim of CPR is to do some of the mechanical work of the heart by forcing at least some blood and oxygen to the brain and other vital organs, which is why chest compressions work.

The only cases in which mouth-to-mouth seems to make a difference is when the victim is a child, or in cases of adults who have stopped breathing because of choking, drowning or other respiratory problems.

The Bee Gees disco song “Stayin’ Alive” might help people stay alive when they get cardiopulmonary resuscitation (CPR) — if their rescuer knows the 1977 tune.

The University of Illinois medical school studied the effect the song had on keeping time during CPR. Five weeks after practicing CPR with the song playing on an iPod, doctors at the medical school were able to hum along without the music and keep time just a little bit faster than 100 per minute, which is perfectly fine when we’re talking about chest compressions.

Stayin’ alive,
Stayin’ alive,
Ha…ah…ah…ah
(this part is exactly 100 beats per minute)
Stayin’ a-li-ive
This tip helps rescuers keep the proper rate while doing CPR. Going too slow doesn’t generate enough blood flow, and going too fast doesn’t allow the heart to fill properly between compressions. Humming along with the Bee Gees is one way to stay on track.

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The American Heart Assoication is adapting a new standard for CPR.  On March 31, an important advisory statement on “hands-only”  (compression-only) CPR was published in Circulation. This statement clarifies the 2005 AHA Guidelines for CPR and ECC, which included the recommendation that laypersons – or bystanders – should perform hands-only CPR if they are unable or unwilling to provide rescue breaths.  The Compliance Resource Center wrote about an article about a new study done in Lancet in April of 2007.  The Lancet study showed dramatic results when life-savers only had to worry about chest compressions without doing mouth-to-mouth breathing. 

”The report confirms that what we have learned in animal experiments applies to humans as well,” says Gordon A. Ewy, MD, director of the Sarver Heart Center at The University of Arizona in Tucson where chest-compression-only resuscitation was developed. “Bystander-initiated continuous chest compressions without mouth-to-mouth breathing are the preferable approach for witnessed unexpected collapse, which is usually due to cardiac arrest.”

Hopefully more people will consider doing CPR (compression only) on a person when needed.  Statistics show that when CPR is started and continued until help arrives, it can save lives.

A unified effort by the public, educators and policymakers is needed to reduce deaths from sudden cardiac arrest by increasing the use and effectiveness of cardiopulmonary resuscitation (CPR), according to a statement from the American Heart Association. The statement, “Reducing barriers for implementation of bystander-initiated cardiopulmonary resuscitation,” appears online in Circulation: Journal of the American Heart Association.

“Bystander cardiopulmonary resuscitation rates are woefully inadequate, resulting in an enormous missed opportunity to save lives from cardiac arrest,” said Benjamin S. Abella, M.D., M.Phil., clinical research director for the Center for Resuscitation Science at the University of Pennsylvania in Philadelphia, and lead author of the statement.

Studies indicate that in many communities only 15 percent to 30 percent of out-of-hospital cardiac arrest victims receive bystander CPR before emergency medical services (EMS) personnel arrive at the scene. Considering that cardiac arrest survival falls an estimated seven percent to 10 percent for every minute without CPR, the low rate of bystander CPR has a big impact on outcomes, he explained.

Approximately 166,200 out-of-hospital sudden cardiac arrest deaths occur annually in the United States. Sudden cardiac arrest often results from an irregular heartbeat called ventricular fibrillation (VF) which causes the heart to quiver so that it cannot generate blood flow. Treatment of VF requires CPR to keep blood moving through the body until the patient’s heart can be shocked to terminate the VF and allow the heart’s pacemaker cells to establish a normal rhythm, AHA officials said.

In the last decade, automated external defibrillators (AEDs), portable defibrillation machines, have become increasingly common in public buildings such as casinos, airports and schools. However, Abella said defibrillation is only one of the four links in the Chain of Survival, a sequence of four actions that must occur quickly to help assure the best chances of survival.

The Chain of Survival requires:
early recognition of the emergency and phoning 911 for EMS.
early bystander CPR.
early delivery of a shock via a defibrillator if indicated.
early advanced life support and post-resuscitation care delivered by healthcare providers.

“Quick initiation of CPR, as well as providing high quality CPR, is crucial to survival,” Abella said. “What’s needed is a two-pronged approach: first, substantially increase the number of bystanders trained in CPR who then provide CPR during an actual emergency and second, improve the quality of training and actual CPR performance through measures of its effectiveness.”

The statement identifies specific potential barriers to improving U.S. cardiac arrest survival rates including: fear of infectious disease, fear of litigation and fear of poor performance, all of which Abella said could be overcome with adequate education, training and public awareness.