The American Heart Association recently released a position statement regarding the use of compression-only CPR without delivering rescue breaths. This statement, intended to clarify CPR training for lay rescuers, was issued to amend and clarify the "2005 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC)" for bystanders who witness an adult out-of-hospital sudden cardiac arrest.

Extensive research, completed since the 2005 guidelines were released, indicates the survival rates for full CPR are no better and no worse than compressions-only CPR. These studies discuss only the situation in which a collapse was witnessed and pertains only to adults in certain situations. The idea is that if the requirement for delivering rescue breaths as part of CPR is removed, bystanders will be more likely to administer care to a collapsed adult. The AHA states, "although bystander CPR can more than double survival from cardiac arrest, the reported prevalence of bystander CPR remains low in most cities (about 27-33 percent). Reducing barriers to bystander action can be expected to substantially improve cardiac arrest survival rates." 

While this change is important with regard to lay rescuers providing emergency care in the event of a collapse on the street, it will not affect the care of an unconscious diver. Many dive injuries involving an unconscious, non-breathing diver begin with respiratory arrest and drowning. DAN Training does not plan to change any DAN courses to feature hands-only CPR, which is relevant to the world at large but does not affect diving circumstances.

"The AHA ECC Committee acknowledges that all victims of cardiac arrest will benefit from the delivery of high-quality chest compressions (compressions of adequate rate and depth with minimal interruptions) but that some cardiac arrest victims (e.g., pediatric victims and victims of drowning, trauma, airway obstruction, acute respiratory diseases and apnea [such as that associated with drug overdose]) may benefit from additional interventions taught in a conventional CPR course. Therefore, the Committee continues to encourage the public to obtain training in CPR to learn the psychomotor skills required to care for a wide range of cardiovascular- and respiratory-related medical emergencies." 

DAN Instructors teaching DAN classes will need to be aware of this change, however. It is possible that as basic-level CPR classes change, students may not know how to perform rescue breathing, depending on their level of experience and training. This will require additional training and practice to develop proficiency at the DAN level.

The following are AHA recommendations:

All victims of cardiac arrest should receive, at a minimum, high-quality chest compressions (i.e., chest compressions of adequate rate and depth with minimal interruptions). To support that goal and save more lives, the AHA ECC Committee recommends the following:

• When an adult suddenly collapses, trained or untrained bystanders should — at a minimum — activate their community emergency medical response system (e.g., call 911) and provide high-quality chest compressions by pushing hard and fast in the center of the chest, minimizing interruptions (Class I).
• If a bystander is not trained in CPR, then the bystander should provide hands-only CPR (Class IIa). The rescuer should continue hands-only CPR until an automated external defibrillator arrives and is ready for use or EMS providers take over care of the victim.
• If a bystander was previously trained in CPR and is confident in his or her ability to provide rescue breaths with minimal interruptions in chest compressions, then the bystander should provide either conventional CPR using a 30:2 compression-to-ventilation ratio (Class IIa) or hands-only CPR (Class IIa). The rescuer should continue CPR until an automated external defibrillator arrives and is ready for use or EMS providers take over care of the victim.
• If the bystander was previously trained in CPR but is not confident in his or her ability to provide conventional CPR including high-quality chest compressions (i.e., compressions of adequate rate and depth with minimal interruptions) with rescue breaths, then the bystander should give hands-only CPR (Class IIa). The rescuer should continue hands-only CPR until an automated external defibrillator arrives and is ready for use or EMS providers take over the care of the victim.

Should you have any questions about this subject and teaching your DAN courses, contact us at 1-800-446-2671 Option 4, +1-919-684-2948, or email us at oxygen@diversalertnetwork.org.