ACLS Guide: Hands-only CPR - cardiac arrest vs. heart attack

ACLS Guide: Hands-only CPR - cardiac arrest vs. heart attack

Ahmed Raza

As of 2008, the use of hands-only cardiopulmonary resuscitation (CPR) became the best practice when attempting to revive victims of cardiac arrest. This is a change from the previous guidelines, which support the use of both chest compression and mouth-to-mouth ventilation.

Hands-only CPR does not eliminate the need for conventional CPR. Based on three major studies and the agreement from the American Heart Association’s Emergency Cardiovascular Care Committee, the hands-only method works just as well when performed on teens and adults.

Hands-only CPR is beneficial in helping to resolve any unease that untrained bystanders may have about performing CPR due to health concerns regarding mouth-to-mouth ventilation. An increase in bystander participation in cases of cardiac arrest may help to improve the victim’s chances of survival.

When to implement hands-only CPR

Implement hands-only CPR when an adult suddenly collapses and is unresponsive.

There are two basic steps to remember, which makes this method a better option for people who are uncomfortable with, or untrained in, conventional CPR methods.

  1. Upon seeing the victim collapse, 911 should immediately be notified either by the person who is preparing to perform CPR or if there are other people nearby, one of them should be instructed to make the call; and get an AED; this saves the CPR provider valuable time.

  2. Immediately after placing the call, firm chest compressions should be started at a rate of 100–120 beats per minute until emergency personnel arrives.

    Note: When performing the traditional method of CPR, there must be 30 chest compressions made at a rescue breathing rate of 100–120 per minute for every two breaths given to the victim. For more detailed guidance check out our CPR training online, CPR renewal online or get ACLS Medical Training.

Cardiac arrest versus heart attack

The term cardiac arrest throws some people off—it is often used interchangeably with heart attack, but they are two different scenarios.

Heart attacks usually occur because a block in an artery prevents blood rich oxygen from reaching the heart. Classic symptoms include: Gripping, heavy chest pain that may often spread to the jaw, either arm, or the back; difficulty breathing; nausea; or fatigue.

Cardiac arrest is when the normal heartbeat is interrupted. The lower chambers of the heart, the ventricles, chaotically quiver (ventricular fibrillation), race (ventricular tachycardia), or may stop pumping altogether—blood then stops circulating. During a cardiac arrest, the victim will suddenly collapse and lose consciousness—the brain is not getting the blood it needs. Other systems, such as the respiratory system, quickly shut down.

The confusion about the difference between cardiac arrest and heart attack is that a heart attack is a common trigger of cardiac arrest. People with “clean” coronary arteries are victims of cardiac arrest as well, for various reasons, including defects in the systems that pump the heart.

Approximately every year, 300,000 Americans suffer cardiac arrest outside of a hospital. Cardiac arrest is often dramatized as occurring in a public place; however, 80% of the time people are in a residential setting or at home. Some stereotypes ring some factuality: a prototypical victim is a man in his 50s or 60s.

Statistics: Hands-only CPR

It is estimated that 94% of people suffering from sudden cardiac arrest die before reaching the hospital. Part of this because only 24% of these victims received any type of CPR from bystanders upon collapse.

The chance of survival when hands-only CPR is given doubles and may even triple if delivered in a timely fashion.

Hands-only CPR is more efficient than conventional CPR for people in whom out-of-hospital cardiac arrest is observed and shocked with public-access automated external defibrillator (AED).

When it came to the patients that were given conventional CPR, only 7.8% survived; this was, however, still better than the 5.2% survival rate of those who did not receive any form of CPR.


Chest-compression-only CPR (CCO-CPR):

Chest compression-only CPR: A meta-analysis:

Bystander-initiated chest compression-only CPR is better than standard CPR in out-of-hospital cardiac arrest:

What is a heart attack:

What is sudden cardiac arrest:

The circulatory system:

Written by on Apr 7, 2017

Sarah has worked in various roles at Coffee Medical Center including nurse, education director, and quality assurance director.

Last reviewed and updated by on Jul 18, 2023

Dr. Jessica is a registered nurse and educator with 20 years of experience in critical care emergency nursing, specializing in patient care, education, and evidence-based practice. She holds multiple certifications and serves as a Patient Safety Coordinator.

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