Dear Participant,

We are very excited to kick off the first ever Lend a Hand, Save a Life CPR Challenge, a statewide campaign that seeks to educate Pennsylvanians on how to respond to sudden cardiac arrest (SCA), a leading killer of Americans.

This campaign is a call to action to EMS providers, health educators, and community leaders to teach the general public about sudden cardiac arrest and train as many people as possible across the Commonwealth in the basic principles of CPR. Together, our aim is to reach 250,000 people by the end of EMS Week (May 26, 2013), and we challenge you to help reach this goal. In the spirit of healthy competition, we look forward to honoring and awarding prizes to the top organizations that reach the most people.

We have created this resource packet to help make your CPR outreach events a success. There are many different activities that you can plan to spread the knowledge of CPR, and we encourage you to do what works best in your community. Collaborate with your local schools, sports teams, colleges, businesses, and community groups, and consider incorporating training into large-scale public events, such as the intermission of a concert, or during half-time at a sports game. This is your chance to be creative and to allow your organization to stand out. Also, don’t forget to share your activities with local media to help spread the word and increase awareness.

Improving survival from cardiac arrest requires a collective community response, which begins with making sure everyone knows how to call 911 and do CPR. Please join us by teaching your own community these simple steps. Together, we can save more lives!

Thank you for your commitment to improving health care in our Commonwealth, and to saving the lives of its citizens. Good luck!

Sincerely,

Joseph W. Schmider Kathryn D. Tucker Michele M. Bolles Director Program Director Senior VP Health Strategies Bureau of Emergency Medical Services Pennsylvania HeartRescue Project Great Rivers Affiliate Pennsylvania Department of Health American Heart Association

Resource Packet Contents

Materials for Training/Education

Sample Script for Hands Only Demonstration for a Crowd…… Page 3

Sample Script for Hands Only CPR Training (short version)….. Page 5

Key Messages for Community Outreach/Training………………… Page 6

Ideas for Community Events………………………………………………… Page 7

Online Resources…………………………………………………………………. Page 8

Promotion

Press Release…………………………………………………………............. Page 9

Flyer Template……………………………………………………………………… Page 11

Talking Points About the Challenge……………………………….……....Page 12

Reference

Fact Sheet: Hands Only CPR…………………………………………………. Page 14

Fact Sheet: About CPR/Sudden Cardiac Arrest……………………… Page 15

Science Advisory Article on Hands-Only CPR………………………… Page 17

SAMPLE SCRIPT FOR HANDS-ONLY CPR DEMONSTRATION (For a crowd, i.e. during half-time of a sports game, or on stage during a concert intermission)

“Hello and thanks for having us here today.

My name is ______________ and I am from the __________Emergency Health Services Council.

We are a not-for-profit organization who work with the Pennsylvania Department of Health --- overseeing the development and improvement of the emergency medical services system in our (# of counties)_ county region --- (Name counties)

As a part of a program called the Pennsylvania HeartRescue Project, we are representing all of the ambulance services and other emergency services in the area … to raise awareness about sudden cardiac arrest and what to do if you see someone collapse…

Our goal is to increase the survival rate from sudden cardiac arrest in our region by 50%...

AND we NEED YOUR HELP!!

With that in mind, we are here with a “gift of life” for you today!

[Someone grabs his chest and starts to collapse]

Would you know what to do if someone suddenly collapsed in front of you?

If you see a teen or adult suddenly collapse, it’s important to act fast. Helping to save a life is easier than you might think.

Just start hands-only CPR

[Someone enters the court and starts to treat the victim in concert with the instructions]

First, shake the person and shout “Are you ok?”

If no response, send someone to call 911 and find an AED, or call 911 yourself.

Then, get directly over the victim. Put the heel of one hand in the center of the chest.

Then put your other hand on top of the first.

With straight arms, push hard and fast in the center of the chest at a rate of 100 times per minute, allowing the chest to recoil each time. (continued on next page)

To keep the beat, think of the song “Stayin Alive” by the Bee-Gees.

[Stayin’ Alive starts to play]

[Volunteers enter the court with manikins --- Surround demonstration and do hands-only CPR to the beat of the music]

Keep pushing until help arrives.

If an AED is available, turn it on and follow the instructions.

[AED arrives --- Someone emphasizes the instructions and uses the AED]

[Music fades down and out until the shock is delivered and CPR starts again]

[Music starts again as CPR continues]

[Music fades out as speaker starts to talk again]

Let’s hope you never have to use hands-only CPR, but if you see a teen or adult suddenly collapse, don’t be afraid to try it.

Remember: Call 911. Then push hard and fast in the center of the chest until help arrives.

Your actions can help save a life.

Every minute that goes by means nearly a 10% less chance that the victim will survive!!

[Victim stands up – high fives person who performed and others]

[Volunteers stand afterwards – turn with their manikins and face the audience]

Ladies and gentleman --- that is our gift to you. The ability to “Lend a Hand and Save a Life”

How about a round of applause for the victim, our volunteers and to _____________for giving us the opportunity to provide this gift to you!!

For more information about how to “Lend a Hand and Save a Life,” stop at the booth or see any one of our volunteers!!

Thank you and please have a happy and safe holiday season (or enjoy your night, etc)….”

[Music plays as volunteers leave the floor]

SAMPLE SCRIPT FOR TEACHING HANDS-ONLY CPR (short version)

Facilitator:

“Would you know what to do if someone collapsed?

If you see a teen or adult suddenly collapse, it’s important to act fast. Helping to save a life is easier than you might think. Just start hands-only CPR.

First, shake the person and shout “Are you ok?” If no response, send someone to call 911 and find an AED, or call 911 yourself.

Then, get directly over the victim. Put the heel of one hand in the center of the chest. Then put your other hand on top of the first.

With straight arms, push hard and fast in the center of the chest at a rate of 100 times per minute, allowing the chest to recoil each time. To keep the beat, think of the song “Stayin Alive” by the Bee-Gees.

Keep pushing until help arrives. If an AED is available, turn it on and follow the instructions.

Let’s hope you never have to use hands-only CPR, but if you see a teen or adult suddenly collapse, don’t be afraid to try it.

Remember: Call 911. Then push hard and fast in the center of the chest until help arrives.

Your actions can help save a life.”

Note: For unconscious children (age 8 or under), or for adult victims of drowning or choking, start regular CPR by pushing 30 times on the center of the chest followed by 2 mouth to mouth breaths. However, even in these cases, hands-only CPR is better than doing nothing.e

KEY MESSAGES FOR COMMUNITY OUTREACH

WHAT IS BYSTANDER CPR? - CPR done by a friend, family member, or anyone who can help if someone collapses and is unresponsive - Life-saving knowledge that everyone needs to know

WHAT IS HANDS-ONLY CPR? - CPR that focuses on immediate chest compressions, and does not include mouth-to-mouth breaths - This simple message reduces barriers to training. It is easier to remember (compared to the previous

approach of teaching rescue breaths), and emphasizes that you can save a life with very basic knowledge and skills

- Hands-only CPR has been proven to be as effective as conventional CPR in treating adult cardiac arrest victims.

- The American Heart Association has recommended hands-only CPR for adults since 2008 BYSTANDER CPR is CRUCIAL to SURVIVAL

- Starting CPR immediately is one of the most critical factors in whether someone survives. Don’t wait until the ambulance arrives. For every minute that passes without CPR, survival decreases by 10%.

- Immediate bystander CPR doubles or triples the chances of survival. - Almost 80% of sudden cardiac arrests happen at home and are witnessed by a loved one. By knowing CPR,

you could help save your loved one’s life.

SUDDEN CARDIAC ARREST CAN HAPPEN to ANYONE, ANYTIME, ANYWHERE - More than 350,000 Americans each year die from SCA, which is more than lung cancer, breast cancer,

prostate cancer, and AIDS combined. - It is not just something that affects elderly or sick people. More than 2,000 young people (under 25) die

each year. Many victims appear healthy and have no known risk factors. - SCA is different from a heart attack. SCA stops the heart due to an electrical problem, and the person

loses consciousness and has no pulse; A heart attack is caused by a block in the blood supply to the heart muscle. A heart attack may cause SCA, but they are not the same.

OVERCOMING FEAR FACTOR: - You can’t hurt the victim. Your actions can only help! - You are legally protected by the Good Samaritan Act.

For additional CPR training, please contact your local American Red Cross or American Heart Association

IDEAS FOR COMMUNITY OUTREACH • Offer short hands-only CPR demos and training sessions during stand-by’s at local events • Hold a mass CPR training event in partnership with local sports teams, clubs and schools • Offer ongoing training at fire stations or other health or training facilities • Encourage businesses and schools to have an emergency response plan • Demonstrate CPR on camera for a local TV network or for a video that can be shared online • Coordinate a survivor celebration event to honor the 911 callers, EMS professionals, and bystanders

who helped save a life • Involve local leaders, media personalities, celebrities, and sports stars who have strong influence and

can be advocates • Volunteer for public appearances, media opportunities, and safety fairs in your community • Organize a CPR flash mob at your local college campus or other public space

If you have manikins available:

• Have participants practice, giving feedback on the following areas that often need attention : o Position hands in the center of the chest o Push with straight arms and elbows locked o Position body for maximum leverage, kneeling directly over the manikin o Allow for the chest to completely release each time o Push fast (100 times per minute) and deep (2 inches)

Sample group activities if you do not have manikins:

• Have participants clap their hands to the beat of “Stayin Alive” by the BeeGees to get a sense of what 100 beats per minute feels like

• Have participants place the heel of their hand in the center of their own chest, between the nipples to understand the correct placement

• Have participants repeat the steps: “Call 911,” “Push Hard and Fast,” “Use an AED” • Show a video of hands-only CPR, or do a live demonstration

ONLINE RESOURCES

Short videos on how to do hands-only CPR 1) http://www.cnn.com/video/#/video/health/2009/10/13/cheat.death.cpr.demo.cnn 2) http://www.heart.org/HEARTORG/CPRAndECC/HandsOnlyCPR/Hands-Only-

CPR_UCM_440559_SubHomePage.jsp

Save-a-Life Simulator and PSA: www.heartrescuenow.com

Examples of CPR flash mobs and other public awareness events for large crowds

1) Mall Flash Mob: http://www.youtube.com/watch?v=nIJG6Bz_7cI 2) Festival Flash Mob: http://www.youtube.com/watch?v=4yICKTywmlA 3) Youth CPR Rap: http://www.youtube.com/watch?v=HGUArT5tro0&feature=relmfu 4) Basketball Game Half-time Demonstration and Flash Mob:

http://www.youtube.com/watch?v=HFeEYumVg9M&NR=1&feature=fvwp

General resources on CPR and Sudden Cardiac Arrest

1) HeartRescue Project: www.heartrescueproject.com 2) American Heart Association: www.heart.org/handsonlycpr 3) Sudden Cardiac Arrest Foundation: www.sca-aware.org 4) Sudden Cardiac Arrest Association: www.suddencardiacarrest.org

School/Youth CPR Programs

1) Anyone Can Save a Life: www.anyonecansavealife.org 2) Be the Beat: www.bethebeat.heart.org 3) Parent Heart Watch: www.parentheartwatch.org

Survivor Resources

1) SCA Survivor Network: http://www.sca-aware.org/sca-survivor-network 2) Survivor Stories: http://www.suddencardiacarrest.org/aws/SCAA/pt/sp/survivors

For certification courses and additional training:

1) American Heart Association: www.heart.org 2) American Red Cross: www.redcross.org

News for Immediate Release Jan. 7, 2013 Department of Health Launches New CPR Education and Training Initiative Harrisburg – A new campaign, “Lend a Hand, Save a Life,” will teach the general public about sudden cardiac arrest (SCA) and train 250,000 people in Pennsylvania in hands-only cardiopulmonary resuscitation (CPR). The American Heart Association (AHA) has been recommending hands-only CPR for adults since 2008. Hands-only CPR has three easy steps: call 911, push hard and fast in the center of the chest, and use an automated external defibrillator (AED) if available. This type of CPR has been proven as effective as CPR with breaths in treating adult cardiac arrest victims. “Sudden cardiac arrest is the leading cause of death among Americans, with 80 percent of events occurring in the home,” said Acting Secretary of Health Michael Wolf. “It’s our hope that this program will successfully educate Pennsylvanians on how to respond because CPR conducted by an immediate bystander in a cardiac event doubles or triples the patient’s chance of survival.” The new campaign is a joint collaboration between the AHA, Department of Health’s Bureau of Emergency Medical Services (EMS) and the Pennsylvania HeartRescue Project. The goal of the campaign is to encourage CPR trainers to collaborate with local schools, sports teams, colleges, businesses and community groups to host CPR training events and incorporate training into large-scale public events, such as five-minute, hands-only CPR demonstrations during halftime at a sports game or during a concert intermission. CPR trainers can register events online at www.heart.org/lendahandsavealife to track the number of people trained and the date and location of the training. Numbers will be reflected on the website so the public can track progress, and prizes will be distributed at an awards ceremony at the close of the campaign to the top participating training groups. “Improving survival from sudden cardiac arrest begins with making sure everyone knows how to immediately call 911 and start CPR,” said Kathryn DiPuppo Tucker, program director of the Pennsylvania HeartRescue Project, a project that seeks to improve survival rates in Pennsylvania by 50 percent. “This campaign is an exciting opportunity to empower individuals and communities, and ultimately save more lives.”

“Very few victims of sudden cardiac arrest outside of a hospital setting survive, as survival rates drop 10 percent for every minute that passes following a cardiac arrest,” said Dr. Jeffrey Mandak, AHA Capital Region board member and cardiologist at Fulton County Medical Center and PinnacleHealth. “EMS often cannot arrive onsite soon enough to save the victim. Increasing familiarity of CPR and the use of AEDs in the community can help to improve chances of survival.” The “Lend a Hand, Save a Life” campaign will run through May 26, 2013, the end of National EMS Week. For additional information on the campaign, please visit www.heart.org/lendahandsavealife. For more information on sudden cardiac arrest, please visit HeartRescue Project at www.heartrescuenow.com. For CPR training, contact the American Heart Association at www.heart.org/cpr or the American Red Cross at www.redcross.org/take-a-class. Media contact: Aimee Tysarczyk or Kait Gillis, 717-787-1783

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ABOUT THE CHALLENGE The Lend a Hand, Save a Life CPR Challenge seeks to educate Pennsylvanians on how to respond to sudden cardiac arrest (SCA), a leading killer of Americans. The campaign is a call to action to EMS providers, health educators, and community leaders to teach the general public about SCA and train 250,000 people across the Commonwealth in bystander CPR, with the overall goal of improving survival rates for out of hospital sudden cardiac arrest. Lend a Hand, Save a Life CPR Challenge

• Partners: Joint collaboration between the Pennsylvania Department of Health Bureau of EMS, the Pennsylvania HeartRescue Project, and the American Heart Association

• Goal: Educate 250,000 people in Pennsylvania to recognize SCA and know how to respond • Model: Encourage EMS agencies and AHA training centers to collaborate with their local schools, sports

teams, colleges, businesses, and community groups to host CPR training events, and incorporate training into large-scale public events (for example, a 5 minute hands-only CPR demo during halftime at a sports game or at intermission of a concert)

• Events: Materials are available to assist groups in their outreach and training, which include a banner, a Resource Packet (including FAQ’s on CPR and SCA, scripts for trainers, event ideas, poster template, and message guide), and give-aways (including wallet cards with hands-only CPR instructions and silicone bracelets with the campaign slogan)

• Tracking: Participating groups should register their events online at www.heart.org/lendahandsavealife to track how many people they trained and the date and location of the training. Numbers will be reflected graphically (ie a “goal thermometer”) so the public will be able to follow progress

• Timeline: Public launch on January 7, 2013 and run through May 26, 2013 (the end of EMS Week); All trainings as of November 1, 2012 can be included and count towards the goal

• Incentives: Prizes will be distributed at a closing awards ceremony to the top groups (based on number of people reached).

Goals:

1) Improve bystander CPR rates in Pennsylvania, as a step towards improving overall survival of out of hospital SCA

2) Train 250,000 people across Pennsylvania in bystander CPR o Focus on hands-only CPR o Emphasize a simple, action-oriented message

3) Increase public awareness of SCA, the importance of knowing how to respond, and the simple steps

to take action o Educate about SCA and that it can happen to anyone (regardless of age, known symptoms) o Educate on the difference between heart attack and SCA

o Promote a social expectation that citizens must help and they are critical to survival o Break down barriers to CPR (ie. fear of harming the victim, or not doing it right) o Encourage confidence and immediate action o Draw public attention to SCA, an overlooked cause of death

4) Develop an integrated community response to SCA by encouraging collaboration among public

officials, emergency medical services, schools, businesses, community organizations, and the general public

5) Strengthen alliances between leaders and stakeholders in the field of sudden cardiac arrest, thus

strengthening the system of care in Pennsylvania Hands-Only CPR Campaign Messaging

• Hands-only CPR has just 3 easy steps (1) Call 911 (2) Push hard and fast in the center of the chest (3) Use an AED if available

• This simple message reduces barriers to training. It is easier to remember (compared to previous approach of teaching rescue breaths, etc), and emphasizes that you can save a life with very basic knowledge and skills

• Hands-only CPR has been proven to be as effective as CPR with breaths in treating adult cardiac arrest victims

• The American Heart Association has recommended hands-only CPR for adults since 2008 • Everyone should know how to call 911, start chest compressions, and find and use an AED

Sudden Cardiac Arrest Facts

• Sudden cardiac arrest is a leading cause of death in the U.S. - killing more than 350,000 Americans each year

• Nationally, only 8% of those who suffer SCA survive - a rate that hasn’t changed significantly in 30 years • Survival rates vary from 1%-50%, depending on where you live in the country; in PA that number is 10% • SCA is a treatable disease. Improving survival requires coordinated community response by the general

public, first responders, EMS services and in-hospital care givers • Success begins with public bystanders. Communities with higher bystander CPR participation have higher

SCA survival rates • Immediate bystander CPR doubles or triples the chance of survival • 80% of SCA events occur in the home

2012 Hands-OnlyTM CPR Fact Sheet Remember disco? You can help save a life if you do.

If you see a teen or adult collapse, call 9-1-1 and push hard and fast in the center of the chest to the

beat of the classic disco song “Stayin’ Alive.” The American Heart Association’s Hands-OnlyTM CPR at

this beat can more than double or triple a person’s chances of survival.

Take 60 seconds and hustle to heart.org/handsonlycpr to learn how you can help save a life.

WHY LEARN HANDS-ONLY CPR?

Sudden cardiac arrest is a leading cause of death. Nearly 400,000 out-of-hospital cardiac arrests

occur annually in the United States.

• When a teen or adult has a sudden cardiac arrest, survival depends on immediately getting

CPR from someone nearby.

• Sadly, 89 percent of people who suffer an out-of-hospital cardiac arrest die because they

don’t receive immediate CPR from someone on the scene.

• Most Americans (70 percent) feel helpless to act during a cardiac emergency because they

don’t know how to administer CPR or they’re afraid of hurting the victim.

BE THE DIFFERENCE FOR SOMEONE YOU LOVE

If you are called on to give CPR in an emergency, you will most likely be trying to save the life of

someone you love: a child, a spouse, a parent or a friend.

• 80 percent of sudden cardiac arrests happen in private or residential settings.

• Unfortunately, only 41 percent of people who experience a cardiac arrest at home, work or in

public get the immediate help that they need before emergency help arrives.

• Hands-Only CPR has been shown to be as effective as conventional CPR for sudden cardiac

arrest at home, at work or in public. It can double or even triple a victim’s chance of survival.

DISCO CAN SAVE LIVES

Hands-Only CPR has just two easy steps: If you see a teen or adult suddenly collapse, (1) Call 9-1-1;

and (2) Push hard and fast in the center of the chest to the beat of the disco song “Stayin’ Alive.”

• According to the American Heart Association, people feel more confident performing Hands-

Only CPR and are more likely to remember the correct rhythm when trained to the beat of the

disco classic “Stayin’ Alive.”

• "Stayin’ Alive" has more than 100 beats per minute, which is the rate you should push on the

chest during CPR.

HUSTLE TO LEARN HOW TO SAVE A LIFE

• Watch the 60-second demo video. Visit heart.org/handsonlycpr to watch the Hands-Only CPR

instructional video and share it with the important people in your life. You can also find a CPR

class near you.

The American Heart Association’s Hands-Only CPR campaign is supported by an educational grant

from the WellPoint Foundation.

NOTE: The AHA still recommends CPR with compressions and breaths for infants and children and victims of

drowning, drug overdose, or people who collapse due to breathing problems.

CPR has origins dating back to the 1700’s. In 1741, The Paris Academy of Sciences officially recommended mouth-to-mouth resuscitation for drowning victims. More than 100 years later in 1891, Dr. Friedrich Maass performed the first equivocally documented chest compression in humans. In 1960, a group of resuscitation pioneers, Drs Peter Safar, James Jude, and William Bennett Kouwenhoven, combined mouth-to-mouth breathing with chest compressions to create Cardiopulmonary Resuscitation, the lifesaving action we now call “CPR.”

In the 1960s, with the formal endorsement of CPR and the start of a program to acquaint physicians with closed-chest cardiac resuscitation, the American Heart Association became the forerunner of CPR training for the general public. Today, through its global Training Network of close to 300,000 Instructors and more than 3500 authorized Training Centers, the AHA trains more than 12 million people annually in CPR, first aid and advanced cardiovascular life support.

Throughout the years, CPR has evolved from a technique performed almost exclusively by physicians and healthcare professionals. Today it’s a lifesaving skill that is simple enough for anyone to learn. However, research has shown that several factors prevent bystanders from taking action, including fear that they will perform CPR incorrectly, fear of legal liability, and fear of infection from performing mouth-to-mouth.

Recommendations outlined in the 2010 AHA Guidelines for CPR & ECC (Emergency Cardiovascular Care) continue to simplify CPR for rescuers, so that more people can and will act in the event of an emergency. However, to get CPR and first aid training into the hands of every person, from healthcare providers to bystanders, the way that the AHA delivers training and information also has evolved.

Through scientific research, the AHA has been able not only to create specialized training for professionals, but to lead the way in developments like Hands-Only™ CPR for bystanders, so that more victims have a chance at survival. It was 2008 when AHA first endorsed Hands-Only CPR – the two-step technique of calling 9-1-1 and pushing hard and fast in the center of the chest until help arrives. Through the AHA’s Hands-Only CPR Ad Council campaign and other exciting initiatives, AHA is spreading the message that anyone can and should learn the simple skills that can save a life.

With its Alliance partner, Laerdal Medical, in 2005, AHA launched the revolutionary CPR Anytime® personal learning program, developed to increase CPR knowledge among the general public. CPR Anytime and Infant CPR Anytime kits contain everything needed to learn basic CPR skills in about 20 minutes. You can learn skills from the comfort of your home or in a group setting, and then share the kit with close family members and friends to pass on skills to others.

About Cardiopulmonary Resuscitation (CPR)

Hands-OnlyTM CPR

To help deliver training to busy healthcare professionals and employees with a duty to respond to emergencies in the workplace, in 2007 AHA created OnlineAHA.org, which today offers a variety of online courses in basic and advanced life support, CPR and first aid, stroke education, rhythm recognition and more. To date, more than 1.25 million people have completed courses through OnlineAHA.org!

The AHA also has been able to create tools for the general public that deliver real-time lifesaving information. The AHA Pocket First Aid & CPR Smartphone Application – AHA’s first app – amazingly helped Dan Wooley, a U.S. filmmaker trapped for more than 60 hours in rubble from the massive January 12, 2010, Haiti earthquake survive. He was able to treat his injuries using information found on the app, which features hundreds of pages of illustrations covering CPR and first aid procedures, and more than 40 detailed videos.

• Every year in the US, EMS treats almost 383,000 out-of-hospital sudden cardiac arrests – that’s more than 1,000 a day.

• Almost 80 percent of sudden cardiac arrests happen at home and are witnessed by a loved one. Put very simply: The life you save with CPR is mostly likely to be the life of someone you love.

• Currently, less than 12 percent of victims survive sudden cardiac arrest. Effective bystander CPR provided immediately after sudden cardiac arrest can double or triple a victim’s chance of survival, but only 41 percent of cardiac arrest victims get CPR from a bystander.

• Sudden cardiac arrest can happen to anyone at any time. Many victims appear healthy with no known heart disease or other risk factors.

• Sudden cardiac arrest is not the same as a heart attack. Sudden cardiac arrest occurs when electrical impulses in the heart become rapid or chaotic, which causes the heart to suddenly stop beating. A heart attack occurs when the blood supply to part of the heart muscle is blocked. A heart attack may cause cardiac arrest.

• African-Americans are almost twice as likely to experience cardiac arrest at home, work or in another public location than Caucasians, and their survival rates are twice as poor as for Caucasians.

• The AHA trains 13 million people in CPR annually, to equip Americans with the skills they need to perform bystander CPR.

• The most effective rate for chest compressions is greater than 100 compressions per minute – the same rhythm as the beat of the BeeGee’s song, “Stayin’ Alive.”

About Cardiopulmonary Resuscitation (CPR) (continued)

Sudden Cardiac Arrest (SCA) & CPR Fast Facts

AHA Pocket First Aid & CPR Smartphone Application

©2012, American Heart Association 2/12DS5580

ISSN: 1524-4539 Copyright © 2008 American Heart Association. All rights reserved. Print ISSN: 0009-7322. Online

72514Circulation is published by the American Heart Association. 7272 Greenville Avenue, Dallas, TX

DOI: 10.1161/CIRCULATIONAHA.107.189380 2008;117;2162-2167; originally published online Mar 31, 2008; Circulation

Roger D. White Michael R. Sayre, Robert A. Berg, Diana M. Cave, Richard L. Page, Jerald Potts and

Heart Association Emergency Cardiovascular Care CommitteeSudden Cardiac Arrest: A Science Advisory for the Public From the American

Action for Bystander Response to Adults Who Experience Out-of-Hospital Hands-Only (Compression-Only) Cardiopulmonary Resuscitation: A Call to

http://circ.ahajournals.org/cgi/content/full/117/16/2162located on the World Wide Web at:

The online version of this article, along with updated information and services, is

http://www.lww.com/reprintsReprints: Information about reprints can be found online at  

journalpermissions@lww.com410-528-8550. E-mail:

Fax:Kluwer Health, 351 West Camden Street, Baltimore, MD 21202-2436. Phone: 410-528-4050. Permissions: Permissions & Rights Desk, Lippincott Williams & Wilkins, a division of Wolters 

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by on October 21, 2009 circ.ahajournals.orgDownloaded from

Hands-Only (Compression-Only) CardiopulmonaryResuscitation: A Call to Action for Bystander Response

to Adults Who Experience Out-of-Hospital SuddenCardiac Arrest

A Science Advisory for the Public From the American Heart AssociationEmergency 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

Bystanders who witness the sudden collapse of an adultshould activate the emergency medical services (EMS)

system and provide high-quality chest compressions by push-ing hard and fast in the middle of the victim’s chest, withminimal interruptions. This recommendation is based onevaluation of recent scientific studies and consensus of theAmerican Heart Association Emergency Cardiovascular Care(ECC) Committee. This science advisory is published toamend and clarify the “2005 American Heart Association(AHA) Guidelines for Cardiopulmonary Resuscitation (CPR)and Emergency Cardiovascular Care (ECC)” for bystanderswho witness an adult out-of-hospital sudden cardiac arrest.

Ten years ago, the AHA commissioned a working group ofresuscitation scientists to reappraise the Association’s inclu-sion of ventilations in the recommended sequence for by-stander cardiopulmonary resuscitation (CPR). The workinggroup evaluated peer-reviewed reports of laboratory andhuman research and summarized their findings in a 1997statement.1 The key conclusion of that statement was that“Current guidelines for performing mouth-to-mouth ventila-tion during CPR should not be changed at this time.”1

In the animal studies cited in the 1997 statement, whenventricular fibrillation arrest was of short (under 6 minutes)duration, the addition of rescue ventilations to chest compres-sions did not improve outcome compared with chest com-pressions alone (LOE 6*).2–8 Analysis of human data from anational out-of-hospital CPR registry documented no survivaladvantage to ventilations plus compressions compared with

the provision of chest compressions alone during bystanderresuscitation (LOE 4*).9,10 Although these studies were notdeemed sufficient to justify the elimination of ventilationsfrom the bystander CPR sequence, the 1997 statementstrongly encouraged further research that would focus on“...the timing, rate, and depth [of ventilations] as well asconditions under which respiratory assistance should beused.” The statement also recommended “...more research onreal-world obstacles to learning, remembering, and actuallyperforming CPR...” In addition, the statement contained asecondary conclusion that “...provision of chest compressionwithout mouth-to-mouth ventilation is far better than notattempting resuscitation at all.”1

The AHA’s recent Guidelines for CPR and ECC havereflected the primary and secondary conclusions of the 1997statement: “Laypersons should be encouraged to docompression-only CPR if they are unable or unwilling toprovide rescue breaths (Class IIa), although the best methodof CPR is compressions coordinated with ventilations.”11,12

In addition, the Guidelines have recommended compression-only CPR for dispatcher-assisted instructions for untrainedbystanders.“11,12

The “2005 AHA Guidelines for CPR and ECC” noted theneed to increase the prevalence and quality of bystander CPR.The Guidelines and training materials emphasized the impor-tance of the delivery of high-quality chest compressions, thatis, compressions of adequate rate and depth with full-chestrecoil and minimal interruptions.12 To limit the frequency of

The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outsiderelationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are requiredto complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.

This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on February 28, 2008. A single reprintis available by calling 800-242-8721 (US only) or by writing the American Heart Association, Public Information, 7272 Greenville Ave, Dallas, TX75231-4596. Ask for reprint No. 71-0444. A copy of the statement is also available at http://www.americanheart.org/presenter.jhtml?identifier�3003999by selecting either the “topic list” link or the “chronological list” link. To purchase additional reprints, call 843-216-2533 or e-mailkelle.ramsay@wolterskluwer.com.

Expert peer review of AHA Scientific Statements is conducted at the AHA National Center. For more on AHA statements and guidelines development,visit http://www.americanheart.org/presenter.jhtml?identifier�3023366.

Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the expresspermission of the American Heart Association. Instructions for obtaining permission are located at http://www.americanheart.org/presenter.jhtml?identifier�4431. A link to the “Permission Request Form” appears on the right side of the page.

(Circulation. 2008;117:2162–2167.)© 2008 American Heart Association, Inc.

Circulation is available at http://circ.ahajournals.org DOI: 10.1161/CIRCULATIONAHA.107.1893802162

AHA Science Advisory

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interruptions, these Guidelines recommended an increasedcompression-to-ventilation ratio of 30:2 for adult victims. Inaddition, the AHA courses increased student practice ofhigh-quality chest compressions with interruptions (includinginterruptions to deliver rescue breaths) limited to 10 secondsor less.

The purpose of this science advisory is to clarify andelaborate on the “2005 AHA Guidelines for CPR and ECC,”with a summary of research published since 2005. In thisadvisory, the studies that were reviewed in preparation for theAHA’s 2000 and 2005 CPR and ECC guidelines are denotedwith an asterisk (*). The peer-reviewed studies that have beenpublished since the “2005 AHA Guidelines for CPR andECC” update are denoted by a double asterisk (**). Thisadvisory uses the Level of Evidence classification schemedeveloped for the “2005 AHA Guidelines for CPR andECC.”12

Efficacy of Treating Cardiac Arrest WithChest Compressions Alone

Animal StudiesIn a porcine model of short-term cardiac arrest (3 minutes ofuntreated ventricular fibrillation arrest) comparison of chestcompressions to conventional CPR has yielded varying re-sults. Dorph et al13 showed equivalent hemodynamics in the2 groups during 10 minutes of CPR but reduced survival inthe group that did not receive the rescue breaths (LOE 6*).Berg et al14 reported reduced integrated coronary perfusionpressure and median left ventricular blood flow among thoseanimals that received rescue breaths during 12 minutes ofhigh-quality 15:2 CPR but no difference in left ventricularmyocardial oxygen delivery or 24-hour, neurologically intactsurvival between animals receiving chest compressions aloneand those receiving the conventional CPR (LOE 6*). Inanother swine study of simulated bystander CPR, Kern et al15

demonstrated that 6 minutes of chest compressions alone witha clamped endotracheal tube resulted in equivalent 24-hoursurvival and good neurological outcomes compared withstandard CPR (LOE 6*). Two animal studies16,17 mimickingsingle-rescuer bystander CPR (using a 15:2 compression:ven-tilation ratio with 16-second pauses in compressions toprovide 2 rescue breaths in 1 study and 30:2 in the other) havedemonstrated better outcomes with continuous compressionscompared with conventional CPR (LOE 6*, **).

It is important to acknowledge that during cardiac arrestwithout lung inflation and ventilation, there is a continuousdecrement of blood oxygen saturation. At some point in time,the possible hemodynamic advantage conferred by continu-ous chest compressions (without ventilations) will be offsetby this reduction in oxygen saturation, and the ultimate resultwill be a compromise in oxygen delivery. One porcinecardiac arrest study18 (3 minutes of untreated ventricularfibrillation, then 12 minutes of CPR) suggests that after 4minutes of continuous chest compressions without rescuebreathing, the delivery of 2 rescue breaths every 100 com-pressions provides a survival advantage over chest compres-sions alone (LOE 6*).

Animal studies19,20 mimicking bystander CPR with goodquality compressions for asphyxia-precipitated cardiac arrestsdemonstrated that the addition of rescue breathing to com-pressions results in much better outcomes than chest com-pressions alone (LOE 6*). Chest compressions alone, how-ever, were superior to no CPR at all, even with asphyxia-precipitated cardiac arrest. These studies support the need forrescue breathing as a critical component of CPR for asphyxia-precipitated cardiac arrests, such as those associated withdrowning, trauma, airway obstruction, acute respiratory dis-eases and apnea (eg, with drug overdoses), pediatric arrests,and prolonged cardiac arrest.

Human Clinical ExperienceSince the 1997 AHA ventilation statement, there have been 5key human studies comparing the efficacy of bystandercompression-only CPR with conventional CPR (Table).These studies are consistent with the animal data and thehuman registry data cited previously.9,10

In 2000, Hallstrom et al21 demonstrated equivalent survivalto hospital discharge in out-of-hospital cardiac arrest victimswho were randomized to receive dispatcher-assisted by-stander CPR instructions for compressions only or compres-sions and mouth-to-mouth ventilations (LOE 2). Waalewijnet al22 reported that the provision of chest compressions alonedid not have a negative influence on survival to hospitaldischarge, compared with conventional CPR (LOE 3*).

Three nonrandomized observational studies of human by-stander CPR were published in 2007, and none of these 3studies demonstrated any negative impact on survival whenventilations were omitted from the bystander sequence. Usingthe important end point of 30-day survival with favorableneurological outcome, it was reported23 that survival afterbystander chest compressions only did not differ from sur-vival after conventional bystander CPR for adult patients withwitnessed out-of-hospital cardiac arrests from both “cardiac”and “noncardiac” causes (LOE 4**). Iwami et al24 reportedno difference in 1-year neurologically intact survival betweenvictims of witnessed cardiac arrest of presumed cardiacetiology who received bystander compressions only and thosewho received conventional CPR (LOE 4**). Bohm et al25

also studied 1-month survival from a registry of all adultvictims of out-of-hospital cardiac arrest who received by-stander CPR and found no statistically significant differencebetween victims that received chest compressions alone andthose that received conventional CPR (LOE 4**). Thesestudies could not assess or control for the quality of bystanderCPR delivered, and all bystanders were likely trained accord-ing to the recommendations published before the “2005International Consensus on Cardiopulmonary Resuscitationand Emergency Cardiovascular Care Science with TreatmentRecommendations”26 or the “2005 AHA Guidelines for CPRand ECC.”12 These 2005 publications emphasized the deliv-ery of more effective chest compressions with minimalinterruptions.

Lay Responder PerformanceHands-only (compression-only) bystander CPR may reducethe time to initiation of CPR and result in delivery of a greater

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number of chest compressions with fewer interruptions forthe first several minutes after adult out-of-hospital cardiacarrest. Several human studies suggest that trained rescuersperforming traditional 1-person CPR take much longer toinitiate CPR than those trained to perform hands-only CPR.This can be explained by the additional cognitive or emo-tional burdens associated with attempting the more complexpsychomotor task of traditional CPR (LOE 6*).27

Studies27,28 of basic life support providers trained beforethe “2005 AHA Guidelines for CPR and ECC” showed thatlay rescuers and healthcare providers who performed conven-tional CPR interrupted chest compressions for much longerthan recommended (16�1 seconds and 10�1 seconds, re-spectively) to provide ventilations and delivered significantlyfewer compressions over time than rescuers performingcontinuous chest compressions (LOE 6*, **). In 1 study,29

there was more “decay” in posttraining performance overtime (18 months) among those trained in conventional CPRthan among rescuers trained in chest compressions only (LOE6*). However, the ability of bystanders to deliver adequaterate and depth of continuous chest compressions for pro-longed durations is unknown and requires further study.

Reducing Barriers to Bystander ActionAlthough bystander CPR can more than double survival fromcardiac arrest,9,30–34 the reported prevalence of bystanderCPR remains low in most cities, about 27% to 33%.23,35–38

Reducing barriers to bystander action can be expected tosubstantially improve cardiac arrest survival rates. Reasonscited prospectively for the reluctance to perform CPR ofteninclude concerns about disease transmission related to per-forming mouth-to-mouth ventilation.39–45 In a study of actualbystanders, Swor et al35 reported that CPR-trained bystandersat the scene of out-of-hospital cardiac arrests most often citedpanic and fear of causing harm as reasons for failing toperform CPR; only 1.4% expressed reluctance to performmouth-to-mouth ventilation, and none cited fear of infection(LOE 3**). Hauff et al46 also found that fear of infectiousdisease was not a prominent concern or obstacle whenbystander CPR instructions were provided by a dispatcher(LOE 4*).

Eliminating the expectation of mouth-to-mouth contact dur-ing CPR is likely to improve esthetics and address the expressedconcern of potential bystanders about infection. SimplifyingCPR training also improves trainees’ ability to learn and per-form, among other things, proper chest compressions (LOE6**).47 Finally, eliminating ventilation instructions in dispatcher-assisted CPR reduces the time required to commence compres-sions, as observed in simulated (LOE 6*,**)48,49 and actualout-of-hospital resuscitations (LOE 2*).21

Who Should Receive Hands-Only CPRFrom Bystanders?

The AHA ECC Committee has carefully considered therelatively low prevalence of bystander CPR and the potential

Table. Clinical Bystander CPR Studies Comparing Chest Compression-Only CPR With Chest Compression Plus Rescue Breathing CPR

StudyPopulation Studied (All Are

Out-of-Hospital) Outcome MeasureNo Bystander

CPR (%)CC-Only CPR

(%)CC � RBCPR (%)

Survival after out-of-hospital cardiac arrests

10. Bossaert et al, 19899. Van Hoeyweghen et al, 1993

All adult cardiac arrests, cardiacand noncardiac causes, with goodquality CC-CPR or good quality CC

� RB-CPR or no CPR

14-day survival 123/2055 (6) 17/116 (15) 71/443 (16)

21. Hallstrom et al, 2000 Prospective, RCT of dispatcherinstructions for all adult cardiac

arrests, excludingpoisoning/overdoses

Discharged alive from hospital — 32/240 (15) 29/278 (10)

22. Waalewijn et al, 2001 All bystander-witnessed adultcardiac arrests with EMS

resuscitation

Discharged alive from hospital 26/429 (6) 6/41 (15) 61/437 (14)

23. Nagao et al, 2007 All witnessed adult cardiacarrests–cardiac and noncardiac

causes

Neurologically favorable1-month survival

63/2917 (2) 27/439 (6)* 30/712 (4)*

24. Iwami et al, 2007 All witnessed adult cardiac arrestsof presumed cardiac origin

Neurologically favorable 1-yearsurvival

70/2817 (3) 19/441 (4) 25/617 (4)

25. Bohm et al, 2007 All cardiac arrests with bystanderCPR including cardiac and

noncardiac causes

1-month survival — 591/8209 (7) 77/1145 (7)

Survival after out-of-hospital for witnessed ventricular fibrillation cardiac arrests only

23. Nagao et al, 2007 45/549 (8) 24/124 (19)† 23/205 (11)†

24. Iwami et al, 2007 44/535 (8) 14/122 (12) 18/161 (11)

CC-only CPR indicates chest compression-only bystander CPR; CC � RB CPR refers to conventional chest compression with rescue breathing bystander CPR; RCT,randomized, controlled trial; EMS, emergency medial services.

*Outcomes were equivalent or better with CC-only CPR compared with CC � RB CPR: unadjusted odds ratio, 1.5 (95% confidence interval, 0.9–2.5), and adjustedodds ratio, 2.2 (95% confidence interval, 1.2–4.2), but many patients could not be included in the adjusted odds ratios. †Outcomes were better with CC-only CPRthan CC � RB CPR: adjusted odds ratio, 2.5 (95% confidence interval, 1.2–4.9). All data are presented as number (percentage).

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that further simplification of CPR instructions might encour-age more bystanders to take appropriate action. Furthermore,the Committee has concluded that adult victims of out-of-hospital cardiac arrest who receive bystander hands-only(compression-only) CPR or conventional CPR have a similarchance of survival. Thus, bystanders can use either hands-only CPR or conventional CPR to achieve the goal ofproviding effective chest compressions (of adequate rate anddepth with minimal interruptions) to adult victims of out-of-hospital sudden cardiac arrest. This “call to action” forbystanders does NOT apply to unwitnessed cardiac arrest,cardiac arrest in children, or cardiac arrest presumed to be ofnoncardiac origin.

The AHA ECC Committee acknowledges that all victimsof cardiac arrest will benefit from delivery of high-qualitychest compressions (compressions of adequate rate and depthwith minimal interruptions) but that some cardiac arrestvictims (eg, pediatric victims and victims of drowning,trauma, airway obstruction, acute respiratory diseases, andapnea [such as that associated with drug overdose]) maybenefit from additional interventions taught in a conventionalCPR course. Therefore, the Committee continues to encour-age the public to obtain training in CPR to learn thepsychomotor skills required to care for a wide range ofcardiovascular- and respiratory-related medical emergencies.

Limitations and CautionsDuring the discussions and review of this science advisory,some experts raised concerns about basing recommendationson animal studies and limited nonrandomized observationalhuman studies. They also raised concerns about the possibil-ity that recommending hands-only CPR for witnessed suddencardiac arrest will, in fact, increase the complexity ofdecision-making for bystanders or that unresponsive victimsof noncardiac medical emergencies (eg, drowning, drugoverdose) will not receive rescue breathing.50,51 The Commit-tee acknowledges those views but considers the hands-onlyCPR recommendation to be sufficiently focused on a specific,easily identified patient population and bystander group. Inaddition, the Committee thinks that this clarification is likelyto increase the incidence of bystander action. In the studies ofbystander CPR cited in this advisory, hands-only(compression-only) CPR was better than no attempt at CPRand produced survival equivalent to conventional CPR.

Many questions remain unanswered. The ECC Committeeacknowledges important limitations in issuing these recom-mendations and the call to action. These recommendationsare based on the best available evidence, but this evidence isfar from complete. Although we believe that making CPReasier to perform will increase the overall performance ofCPR by bystanders, this remains unproven in clinical trials.There may be situations in which ventilation alone could belife-saving but is not provided. There may be an interval aftercardiac arrest when ventilations become absolutely criticalfor survival. There could be confusion on the part of bystand-ers who have been previously trained in conventional CPR.The impact of implementing these recommendations for adultvictims could adversely affect some pediatric victims (ifincorrectly applied) or other victims of asphyxial arrest. New

teaching methods may emerge that improve the ability ofbystanders to learn and perform effective compressions andventilations during conventional CPR. After careful consid-eration, weighing all the known evidence, and considering themany unanswered questions, the ECC Committee held thatthe likely advantages in favor of this recommendation out-weigh the possible disadvantages.

Recommendations and Call to ActionAll victims of cardiac arrest should receive, at a minimum,high-quality chest compressions (ie, chest compressions ofadequate rate and depth with minimal interruptions). Tosupport that goal and save more lives, the AHA ECCCommittee recommends the following.

When an adult suddenly collapses, trained or untrainedbystanders should—at a minimum—activate their communityemergency medical response system (eg, call 911) andprovide high-quality chest compressions by pushing hard andfast in the center of the chest, minimizing interruptions (Class I).

● If a bystander is not trained in CPR, then the bystandershould provide hands-only CPR (Class IIa). The rescuershould continue hands-only CPR until an automated exter-nal defibrillator arrives and is ready for use or EMSproviders take over care of the victim.

● If a bystander was previously trained in CPR and isconfident in his or her ability to provide rescue breathswith minimal interruptions in chest compressions, then thebystander should provide either conventional CPR using a30:2 compression-to-ventilation ratio (Class IIa) or hands-only CPR (Class IIa). The rescuer should continue CPRuntil an automated external defibrillator arrives and isready for use or EMS providers take over care of thevictim.

● If the bystander was previously trained in CPR but is notconfident in his or her ability to provide conventional CPRincluding high-quality chest compressions (ie, compres-sions of adequate rate and depth with minimal interrup-tions) with rescue breaths, then the bystander should givehands-only CPR (Class IIa). The rescuer should continuehands-only CPR until an automated external defibrillatorarrives and is ready for use or EMS providers take over thecare of the victim.

The ECC Committee strongly recommends that the AHAand other research funding organizations (eg, the NationalInstitutes of Health) act aggressively in the public’s interest tofund research that will answer the important unansweredquestions cited in this advisory. Only with new research andadditional evidence will future guidelines be able to recom-mend optimal methods for bystander CPR. Funding to con-duct this high-impact research that directly affects so manylives should be prioritized.

The scope of this recommendation is limited to a “call toaction” for bystanders as they care for an adult who hasexperienced a witnessed, out-of-hospital cardiac arrest of prob-able cardiac origin (eg, sudden collapse or collapse after signsconsistent with a myocardial infarction). As such, it is meant toclarify the “2005 AHA Guidelines for CPR and ECC” on this

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topic. The science volunteers of the ECC Committee and theBasic Life Support Subcommittee continue to participate in theinternationally based evaluation of resuscitation science spon-sored by the International Liaison Committee on Resuscitation(ILCOR) and the AHA. As a part of both the ILCOR evaluation

and ongoing AHA activities, ECC Committee members andBasic Life Support Subcommittee members will continue tomonitor and evaluate peer-reviewed studies related to lay rescuerand healthcare provider resuscitation attempts for victims of allcauses of cardiac arrest.52

Disclosures

References1. Becker LB, Berg RA, Pepe PE, Idris AH, Aufderheide TP, Barnes TA,

Stratton SJ, Chandra NC. A reappraisal of mouth-to-mouth ventilationduring bystander-initiated cardiopulmonary resuscitation: a statement forhealthcare professionals from the Ventilation Working Group of theBasic Life Support and Pediatric Life Support Subcommittees, AmericanHeart Association. Circulation. 1997;96:2102–2112.

2. Berg RA, Kern KB, Sanders AB, Otto CW, Hilwig RW, Ewy GA.Bystander cardiopulmonary resuscitation: is ventilation necessary? Cir-culation. 1993;88(Pt 1):1907–1915.

3. Noc M, Weil MH, Tang W, Turner T, Fukui M. Mechanical ventilationmay not be essential for initial cardiopulmonary resuscitation. Chest.1995;108:821–827.

4. Berg RA, Wilcoxson D, Hilwig RW, Kern KB, Sanders AB, Otto CW,Eklund DK, Ewy GA. The need for ventilatory support during bystanderCPR. Ann Emerg Med. 1995;26:342–350.

5. Berg RA, Kern KB, Hilwig RW, Berg MD, Sanders AB, Otto CW, EwyGA. Assisted ventilation does not improve outcome in a porcine modelof single-rescuer bystander cardiopulmonary resuscitation. Circulation.1997;95:1635–1641.

6. Berg RA, Kern KB, Hilwig RW, Ewy GA. Assisted ventilation during‘bystander’ CPR in a swine acute myocardial infarction model does notimprove outcome. Circulation. 1997;96:4364–4371.

7. Idris AH, Becker LB, Fuerst RS, Wenzel V, Rush WJ, Melker RJ, OrbanDJ. Effect of ventilation on resuscitation in an animal model of cardiacarrest. Circulation. 1994;90:3063–3069.

8. Idris AH, Wenzel V, Becker LB, Banner MJ, Orban DJ. Does hypoxia orhypercarbia independently affect resuscitation from cardiac arrest?Chest. 1995;108:522–528.

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Belgian Cerebral Resuscitation Study Group. Resuscitation. 1993;26:47–52.

10. Bossaert L, Van Hoeyweghen R. Bystander cardiopulmonary resusci-tation (CPR) in out-of-hospital cardiac arrest: the Cerebral ResuscitationStudy Group. Resuscitation. 1989;17(suppl):S55–S69; DiscussionS199–S206.

11. Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Car-diovascular Care, part 3: adult basic life support: the American HeartAssociation in collaboration with the International Liaison Committee onResuscitation. Circulation. 2000;102(suppl 8):I22–I59.

12. 2005 American Heart Association Guidelines for CardiopulmonaryResuscitation and Emergency Cardiovascular Care. Circulation. 2005;112(suppl 24):IV1–IV203.

13. Dorph E, Wik L, Strømme TA, Eriksen M, Steen PA. Oxygen deliveryand return of spontaneous circulation with ventilation:compression ratio2:30 versus chest compressions only CPR in pigs. Resuscitation. 2004;60:309–318.

14. Berg RA, Sanders AB, Kern KB, Hilwig RW, Heidenreich JW, PorterME, Ewy GA. Adverse hemodynamic effects of interrupting chest com-pressions for rescue breathing during cardiopulmonary resuscitation forventricular fibrillation cardiac arrest. Circulation. 2001;104:2465–2470.

15. Kern KB, Hilwig RW, Berg RA, Ewy GA. Efficacy of chestcompression-only BLS CPR in the presence of an occluded airway.Resuscitation. 1998;39:179–188.

16. Kern KB, Hilwig RW, Berg RA, Sanders AB, Ewy GA. Importance ofcontinuous chest compressions during cardiopulmonary resuscitation:improved outcome during a simulated single lay-rescuer scenario. Circu-lation. 2002;105:645–649.

17. Ewy GA, Zuercher M, Hilwig RW, Sanders AB, Berg RA, Otto CW,Hayes MM, Kern KB. Improved neurological outcome with continuouschest compressions compared with 30:2 compressions-to-ventilations car-

Writing Group Disclosures

Writing GroupMember Employment

ResearchGrant

OtherResearchSupport

Speakers’Bureau/

HonorariaExpert

Witness Ownership Interest

Consultant/AdvisoryBoard Other

Robert B. Berg University of Arizona None None None None None None None

Diana M. Cave Oregon Health &Sciences University

None None None None None None None

Richard L. Page University of Washington None None None None None None None

Jerald Potts American HeartAssociation

None None None None The American HeartAssociation

produces andmarkets CPR

training materials

None None

Michael R. Sayre Ohio State University None None None None None None *Member of the Board ofDirectors for Take HeartAmerica: Sudden CardiacArrest Survival Initiative,

which is promotingwidespread CPR training

Roger D. White Mayo Clinic None None None None None None None

This table represents the relationships of writing group members that may be perceived as actual or reasonably perceived as conflicts of interest as reported onthe Disclosure Questionnaire, which all members of the writing group are required to complete and submit. A relationship is considered to be “significant” if (a) theperson receives $10 000 or more during any 12-month period or 5% or more of the person’s gross income; or (b) the person owns 5% or more of the voting stockor share of the entity or owns $10 000 or more of the fair-market value of the entity. A relationship is considered to be “modest” if it is less than “significant” underthe preceding definition.

*Modest.

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diopulmonary resuscitation in a realistic swine model of out-of-hospitalcardiac arrest. Circulation. 2007;116:2525–2530.

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19. Berg RA, Hilwig RW, Kern KB, Babar I, Ewy GA. Simulated mouth-to-mouth ventilation and chest compressions (bystander cardiopulmonaryresuscitation) improves outcome in a swine model of prehospital pediatricasphyxial cardiac arrest. Crit Care Med. 1999;27:1893–1899.

20. Berg RA, Hilwig RW, Kern KB, Ewy GA. “Bystander” chest com-pressions and assisted ventilation independently improve outcome frompiglet asphyxial pulseless “cardiac arrest.” Circulation. 2000;101:1743–1748.

21. Hallstrom A, Cobb L, Johnson E, Copass M. Cardiopulmonary resusci-tation by chest compression alone or with mouth-to-mouth ventilation.N Engl J Med. 2000;342:1546–1553.

22. Waalewijn RA, Tijssen JG, Koster RW. Bystander initiated actions inout-of-hospital cardiopulmonary resuscitation: results from theAmsterdam Resuscitation Study (ARRESUST). Resuscitation. 2001;50:273–279.

23. Cardiopulmonary resuscitation by bystanders with chest compressiononly (SOS-KANTO): an observational study. Lancet. 2007;369:920–926.

24. Iwami T, Kawamura T, Hiraide A, Berg RA, Hayashi Y, Nishiuchi T,Kajino K, Yonemoto N, Yukioka H, Sugimoto H, Kakuchi H, Sase K,Yokoyama H, Nonogi H. Effectiveness of bystander-initiatedcardiac-only resuscitation for patients with out-of-hospital cardiac arrest.Circulation. 2007;116:2900–2907.

25. Bohm K, Rosenqvist M, Herlitz J, Hollenberg J, Svensson L. Survival issimilar after standard treatment and chest compression only in out-of-hospital bystander cardiopulmonary resuscitation. Circulation. 2007;116:2908–2912.

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28. Higdon TA, Heidenreich JW, Kern KB, Sanders AB, Berg RA, HilwigRW, Clark LL, Ewy GA. Single rescuer cardiopulmonary resuscitation:can anyone perform to the guidelines 2000 recommendations? Resusci-tation. 2006;71:34–39.

29. Heidenreich JW, Sanders AB, Higdon TA, Kern KB, Berg RA, Ewy GA.Uninterrupted chest compression CPR is easier to perform and rememberthan standard CPR. Resuscitation. 2004;63:123–130.

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KEY WORDS: AHA Scientific Statement � cardiopulmonary resuscitation� death, sudden � heart arrest � resuscitation

Sayre et al Hands-Only Bystander CPR 2167

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