Hands-only CPR, 911 dispatchers get lifesaving nod

ATLANTA | More bystanders are willing to attempt CPR if an emergency dispatcher gives them firm and direct instructions — especially if they can just press on the chest and skip the mouth-to-mouth resuscitation, according to new research.

The two new studies conclude that “hands-only” chest compression is enough to save a life. They are the largest and most rigorous yet to suggest that breathing into a victim’s mouth isn’t needed in most cases.

The American Heart Association has been promoting hands-only CPR for two years, though it’s not clear how much it’s caught on. The new studies should encourage dispatchers and bystanders to be more aggressive about using the simpler technique.

“That could translate into hundreds if not thousands of additional lives saved each year. What are we waiting for?” said Dr. Arthur Kellermann, a Rand Corp. expert on emergency medicine.

An estimated 310,000 Americans die each year of cardiac arrest outside hospitals or in emergency rooms. Only about 6 percent of those who are stricken outside a hospital survive.

When someone collapses and stops breathing, many people panic and think that phoning 911 is the best they can do to help. The larger of the two new studies reported survival rates of about 12 percent when bystanders did dispatcher-directed CPR, confirming earlier research that on-scene CPR can dramatically increase a victim’s odds of survival.

The studies also spotlighted the importance of having forceful dispatchers coaching bystanders, said Dr. Michael Sayre, an Ohio State University emergency-medicine specialist who helped update the Heart Association guidelines on CPR.

Previous research has suggested that adults who need CPR get it only about one-quarter to one-third of the time when bystanders are around. One of the new studies found that when dispatchers told callers to start CPR, about 80 percent attempted it when given hands-only instructions, more than the 70 percent who tried the standard version.

Dr. Sayre and others credited the increase on dispatchers who immediately told callers what to do, instead of first asking them whether they had CPR training or would be willing to try it until medical help arrives.

“This study shows that with great training and motivation, the 911 call taker can make a big difference,” Dr. Sayre said.

CPR, or cardiopulmonary resuscitation, is a technique that’s been in use for about 50 years. The standard version now calls for alternating 30 hard pushes on a victim’s chest with two quick breaths into their mouth.

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.

One of the new studies, carried out in London and the Seattle area, involved more than 1,900 people who witnessed someone in cardiac arrest and called 911 or some other emergency number. Emergency dispatchers instructed callers to do either hands-only CPR or an older form of standard CPR that alternates 15 pushes with two quick breaths.

The second study was done in Sweden and included nearly 1,300 cases.

In both studies, there was no significant difference in the survival rates of people who got conventional CPR and those who got the hands-only version. The studies are being published in Thursday’s New England Journal of Medicine.

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