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Hands-Only (Compression-Only) Cardiopulmonary Resuscitation: A Call to
Action for Bystander Response to Adults Who Experience Out-of-Hospital
Sudden Cardiac Arrest. A Science Advisory for the Public From the American
Heart Association Emergency Cardiovascular Care Committee
Michael R. Sayre, Robert A. Berg, Diana M. Cave, Richard L. Page, Jerald Potts and
Roger D. White
Circulationpublished online Mar 31, 2008;
DOI: 10.1161/CIRCULATIONAHA.107.189380
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AHA Science Advisory
Hands-Only (Compression-Only) Cardiopulmonary
Resuscitation: A Call to Action for Bystander Response
to Adults Who Experience Out-of-Hospital Sudden
Cardiac Arrest
A Science Advisory for the Public From the American HeartAssociation
Emergency Cardiovascular Care Committee
Michael R. Sayre, MD; Robert A. Berg, MD, FAHA; Diana M. Cave, RN, MSN;
Richard L. Page, MD, FAHA; Jerald Potts, PhD, FAHA; Roger D. White, MD

B

ystanders who witness the sudden collapse of an adult
should activate the emergency medical services (EMS)
system and provide high-quality chest compressions by pushing hard and fast in the middle ofthe victim’s chest, with
minimal interruptions. This recommendation is based on
evaluation of recent scientific studies and consensus of the
American Heart Association Emergency Cardiovascular Care
(ECC) Committee. This science advisory is published to
amend and clarify the “2005 American Heart Association
(AHA) Guidelines for Cardiopulmonary Resuscitation (CPR)
and Emergency CardiovascularCare (ECC)” for bystanders
who witness an adult out-of-hospital sudden cardiac arrest.
Ten years ago, the AHA commissioned a working group of
resuscitation scientists to reappraise the Association’s inclusion of ventilations in the recommended sequence for bystander cardiopulmonary resuscitation (CPR). The working
group evaluated peer-reviewed reports of laboratory and
human research andsummarized their findings in a 1997
statement.1 The key conclusion of that statement was that
“Current guidelines for performing mouth-to-mouth ventilation during CPR should not be changed at this time.”1
In the animal studies cited in the 1997 statement, when
ventricular fibrillation arrest was of short (under 6 minutes)
duration, the addition of rescue ventilations to chest compressions did notimprove outcome compared with chest compressions alone (LOE 6*).2– 8 Analysis of human data from a
national out-of-hospital CPR registry documented no survival
advantage to ventilations plus compressions compared with

the provision of chest compressions alone during bystander
resuscitation (LOE 4*).9,10 Although these studies were not
deemed sufficient to justify the elimination ofventilations
from the bystander CPR sequence, the 1997 statement
strongly encouraged further research that would focus on
“...the timing, rate, and depth [of ventilations] as well as
conditions under which respiratory assistance should be
used.” The statement also recommended “...more research on
real-world obstacles to learning, remembering, and actually
performing CPR...” In addition, the...