In the United States, Sudden Cardiac Arrest (SCA) occurs more than 1,000 times a day. When it strikes, a person suddenly becomes unresponsive, stops breathing, or may only be gasping.
During SCA, the heart stops pumping blood and enters a lethal, irregular rhythm called Ventricular Fibrillation (VF). High-quality chest compressions are required to keep oxygenated blood circulating to the heart and brain until a defibrillator can shock the heart back into a normal rhythm. Without compressions, irreversible brain damage can occur in as little as 4–6 minutes.
Why “Hands-Only”?
For witnessed SCA in adults, the immediate problem isn’t a lack of oxygen—it’s a lack of circulation. This is why mouth-to-mouth is no longer the first priority for bystanders. Ventilations can be delayed until an AED arrives with a pocket mask or EMTs reach the scene (which takes an average of 6–8 minutes).
How to Perform Hands-Only™ CPR
Detailed steps according to American Heart Association (AHA) guidelines:
- Ensure Scene Safety: Check your surroundings before approaching.
- Check Responsiveness: Tap the person and shout. If they are unresponsive, point to a specific person and say: “Call 911 and get an AED!”
- Check for Breathing: Pro tip- place your hand on their abdomen for 10 seconds. If they are not breathing (or only gasping), begin compressions.
- Positioning: Kneel beside the person. Place the heel of one hand in the center of the chest. Place the other hand on top, lace your fingers together, and lock your elbows.
- The Technique: Position your shoulders directly over your hands. Push hard and fast, using your body weight to reach a depth of at least 2 inches.
- The Tempo: go to the beat of the Bee Gees song ‘staying alive’. Be sure to let the chest fully recoil between every compression.
- Rotate: Switch with another person every 100 compressions to prevent fatigue.
- Use the AED: If an AED arrives, turn it on and follow the promts.
- Don’t Stop: Continue until the person shows signs of life or EMT’s arrive.
Note: The concept of Continuous Chest Compressions (CCC) was pioneered by the Sarver Heart Center and officially adopted by the AHA as Hands-Only™ CPR in 2008.
When Hands-Only™ CPR is NOT Enough
In certain scenarios, conventional CPR (including rescue breaths) is still required:
- Infants and children
- Drowning victims
- Airway obstructions (choking)
- Head injuries
- Respiratory arrest (smoke inhalation or drug overdose)
- Unwitnessed cardiac arrest
A note on safety: Mouth-to-mouth is generally intended for friends and family. For others, always use a pocket mask or airway device to protect against disease transmission.
Your First Step: Get Certified
Reading a guide is a great start, but nothing replaces the confidence gained through hands-on practice.
As San Francisco’s most trusted AHA Training Site, Revive CPR has provided expert BLS and CPR certification since 2010. Our classes are 100% instructor-led—no “voice-assisted manikins” here.
Revive CPR 148 Townsend St., San Francisco, CA 94107
Roy Gordon, AHA BLS, CPR Instructor/EMT
Hands-only CPR is a trademark of the American Heart Association
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AHA BLS certification is valid for two years.
