American Heart Association Endorses Chest-Compression-Only CPR
Improved bystander protocol for cardiac arrest was pioneered at The University of Arizona.

By Daniel Stolte, Sarver Heart Center
April 1, 2008

The American Heart Association has updated its CPR guidelines and now advocates continuous chest compressions, a method developed at The University of Arizona Sarver Heart Center.

In the April 1 issue of Circulation, the American Heart Association encourages bystanders to help adults who suffer sudden cardiac arrest by providing “high-quality chest compressions by pushing hard and fast in the middle of the victim’s chest, with minimal interruptions.”

Authored by the AHA’s Emergency Cardiovascular Care Committee, which includes Robert Berg, a member of the Sarver Heart Center, the statement addresses the fact that Chest-Compression-Only bystander CPR may result in individuals being more willing to initiate bystander CPR.

This will likely result in delivery of a greater number of chest compressions with fewer interruptions to adults with out-of-hospital cardiac arrest.

“This statement is an extremely important step forward, and we are happy that this change did not have to wait until the 2010 American Heart Association Guideline update,” said Dr. Gordon A. Ewy, director of the Sarver Heart Center at the UA College of Medicine. The Sarver Heart Center Resuscitation Research Group developed Chest-Compression-Only CPR.

“We have recommended this approach for bystanders since 1993, after we found in our experimental laboratory that survival was better with Chest-Compression-Only CPR compared to doing nothing until the simulated arrival of paramedics. It is gratifying to see the AHA make this important endorsement as we think it will help save thousands of lives."

After Sarver Heart Center researcher Karl Kern, in collaboration with resuscitation researchers in the United Kingdom, discovered that the "two quick breaths" standard CPR called for between chest compressions took an average of 16 seconds to complete, laboratory experiments at the Sarver Heart Center revealed that survival was better with Chest-Compression-Only CPR.

In the meantime, several observational studies in humans reported Chest-Compression-Only or Continuous-Chest-Compression CPR produced the same survival as standard CPR. In a previous publication, Ewy noted, "It is interesting that Continuous-Chest-Compression CPR, a technique that has not been advocated or taught and is most often performed by individuals not trained in CPR, results in a survival rate similar to that of our guidelines-advocated approach, on which millions of hours and millions of dollars have been spent in education and advocacy."

In 2007, the Resuscitation Research Group reported that neurological normal survival was better with Chest-Compression-Only CPR even when compared to the updated guidelines calling for 30 chest compressions between 2 breaths.

“Compression-Only CPR is much simpler to perform than traditional CPR and therefore bystanders are more likely to do it,” Ewy said. “Most importantly, the new recommendations remove the largest obstacle, the requirement for mouth-to-mouth ventilation, commonly called 'rescue breathing,' that has kept many bystanders from taking appropriate action.”

Instructions for Chest-Compression-Only CPR for the lay public have been previously published by Ewy. The authors of the AHA statement point out that “this ‘call to action’ does not apply to unwitnessed cardiac arrest, cardiac arrest in children or cardiac arrest presumed to be of non-cardiac origin.”

Extra info

To learn about Compression-Only CPR or to watch an online tutorial visit


The UA Sarver Heart Center offers free demonstration classes in Compression-Only CPR for the public.


The classes are held at 5:30 p.m. at the University Medical Center's Duval Auditorium, located at 1501 N. Campbell Avenue. 


The next classes will be held on April 2 and April 16.  




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Daniel Stolte