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CPR Changes and “Hands-Only” CPR

Occupational Health and Safety | January 30, 2013

Author: Sue Engman Lazear, RN, MN


A number of advances have been recently recommended by experts for performing CPR (cardiopulmonary resuscitation). These changes reflect current research based upon successful outcomes of victims who received CPR from a bystander.

C-A-B, not A-B-C

There are two important changes to CPR protocol. The first is the order in which the steps are performed. The recommended method is to perform compressions (“C”) first, then provide airway (“A”) and breathing (“B”) support. Thus, the new method is known by the acronym C-A-B, which replaces the A-B-C method that was recommended previously.

The use of rescue breathing and airway support has taken a backseat to good chest compressions. But for victims of drowning, breathing and airway support can be very advantageous. Each individual rescuer should evaluate their ability to perform good rescue breathing.  If the rescuer is confident in their ability to manage the airway and perform rescue breathing, then this can be attempted.

The 30:2 Rule

The second change to CPR performance is that the recommended compression to breathing ratio is now 30:2. This means that the rescuer immediately performs 30 good, deep compressions (at least two inches in depth in adults) followed by two rescue breaths.

Rescue breaths should take at least one second each to administer. Rescuers should allow the victim’s chest to fully rise and fall between the breaths. The administration of these two breaths should be completed in less than 10 seconds. Then, compressions at a rate of at least 100/minute should again be initiated. Allow the chest to return to its normal position between each compression, and minimize interruptions to the compression sequence. This 30:2 ratio is recommended for all children and adult victims.

“Hands-Only” CPR

Experts now endorse a new method of performing CPR.  Hands-Only CPR (without rescue breathing) is a simplified method, and should be instituted any time that an adult suffers a sudden collapse and is unresponsive. Hands-Only CPR is the performance of chest compressions at a rate of at least 100 compressions per minute.

Many individuals are concerned about performing rescuing breathing on a stranger, which prevents them from taking action. Remember that it is better to do something than nothing, so take action!


Place your hands in the middle of the victim’s chest and perform chest compressions hard and fast. If you feel comfortable performing rescue breathing, provide 30 compressions followed by two breaths. If rescue breathing is not attempted, continuously compress the chest at a rate of 100 compressions/minute.  While performing compressions, hum the song “Stayin’ Alive” by the Bee Gees and keep up with the rhythm.
CPR can make a big difference in the life of someone who has suffered a collapse. For further information, consider taking a CPR class offered in your local community. The more you know, the more confident you will be in an emergency situation.


Sue Engman Lazear, RN, MN, is a nurse educator based in the Seattle area. She has been teaching for over 25 years and is the Subject Matter Expert for’s Occupational Health and Safety courses on CPR, Blood-Borne Pathogens, and In-Flight Medical Emergencies.

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