Jasmeet Soar and Jerry Nolan, both prominent authors and editors in the field of resuscitation report on a very recent paper by Sayre et al which states: “Hands-only (compression-only) CPR: a call to action for bystander response to adults who experience out-of hospital sudden cardiac arrest.” The thrust of this paper is an encouragement of bystanders to provide at least chest compressions.

The theoretical advantages of compression-only CPR is that it is easier to learn than conventional resuscitation and that any method of CPR provides better outcomes than no CPR at all. Indeed, when response times were short, one study has shown improved outcome in a compression-only group compared to conventional bystander CPR (10% vs 5% favourable neurological outcome). Potential groups who are likely to be disadvantaged by compression-only CPR include children, drowning, trauma, airway obstruction, those having primary respiratory arrest and prolonged cardiac arrest. The lay-public, who provide bystander CPR in approximately 1/3rd of the annual 30,000 ambulance-treated cardiac arrests, generally are not trained to distinguish between primary cardiac and primary respiratory arrest. Therein is the dilemma in bystander CPR training. Ongoing evaluation of compression-only CPR will be presented at the 2010 Consensus conference. In the meantime, current UK guidelines advise lay rescuers not trained in CPR or those unwilling to give mouth to mouth ventilation to give compression-only CPR at a rate of 100/minute.