Forget Mouth-to-Mouth: Here’s the New Way to Perform CPR

Updated: Jul 12, 2021


Performing CPR dramatically increases the chance a person in cardiac arrest will survive. Getty Images

  • Hands-only CPR is just as effective as traditional CPR with rescue breathing.

  • You should push down at least 2 inches when performing chest compressions.

  • Less than 50 percent of people who have a cardiac arrest outside of a hospital get CPR.

Cardiopulmonary resuscitation, or CPR, is a technique used across the world to help revive a person when their heart has stopped beating. However, the traditional way to perform it is falling out of favor.

You’ve seen it on TV and perhaps even in real life. Someone is in critical condition while another is pushing on their chest and occasionally giving mouth-to-mouth rescue breaths. Despite this popularized technique, it may not be the best way to perform CPR.

Studies now show that compression-only CPR, meaning no mouth-to-mouth, is just as effective as traditional CPR.

“It’s easier for people to do hands-only CPR, so it’ll likely be done more often,” Dr. Vidor E. Friedman, FACEP, president of the American College of Emergency Physicians, told Healthline.

In a recent study published in the journal Circulation, performing hands-only CPR doubles a person’s odds of surviving at least 30 days after a cardiac arrest. This is the same rate as traditional CPR that involves rescue breaths.

This study involved over 30,000 people between 2000 and 2017 in Sweden, when hands-only CPR was adopted into the Swedish CPR guidelines.

By removing the rescue breaths between chest compressions, there was a sixfold increase in hands-only CPR use throughout the study.

“The breathing component of CPR is generally not effective, so pumping the blood to preserve organs is the most important thing to do,” said Dr. Theodore Strange, physician and associate chair of medicine at Staten Island University Hospital.

Strange had firsthand experience when he saved a stranger’s life while they were running the New York City Marathon.


Why are more people not doing CPR?

Less than 50 percent of people who experience an out-of-hospital cardiac arrest are getting CPR, according to the American Heart Association. Research has shown that the public hesitates because of a lack of training, doing it wrong despite having training, and even the legal consequences associated with performing this life-saving measure.

Many people even hesitate doing CPR because of a fear of diseases.

“People are concerned about diseases and germs, and hands-only CPR opens up an opportunity to people who may have an issue performing mouth-to-mouth,” Friedman told Healthline. He continued, “Hands-only CPR is simpler and as effective as traditional CPR, and it decreases resistance points for the public to perform it.”

Although Good Samaritan lawsTrusted Source are different in each state, there are protections in place to prevent litigation in cases where bystanders performed CPR with good intention. Despite state differences, the American College of Emergency Physicians has created policy statements encouraging widespread passage of laws eliminating any legal liability for good faith CPR.


CPR is easy to perform

Despite some hesitation to perform CPR, hands-only CPR is a simple task. After calling 911, do the following:

  1. Place the person on their back, and kneel by their side.

  2. Place the heel of one of your hands on the center of the person’s chest, and place the heel of the other hand on top of the first hand. Lace your fingers together.

  3. Keeping your elbows straight, compress the chest to the beat of the 1970s song “Stayin’ Alive” by the Bee Gees, or at a rate of 100 to 120 compressions per minute.

“Hands-only CPR has historically been shown to be effective. The key is quick recognition of a cardiac event and starting compressions immediately,” said Strange.

One common mistake performed by those doing CPR is chest compressions that aren’t deep enough. Studies show that to have effective chest compressions, the person performing CPR should push down at least 2 inches deep. In this process, they should allow complete rise of the chest after the compression to ensure appropriate perfusion, or blood flow.

Each year, there are over 135 million cardiovascular deaths worldwide, including over 475,000 Americans. This is more than breast cancer, colorectal cancer, prostate cancer, pneumonia, auto accidents, influenza, HIV, firearms, and house fires combined.

More than 350,000 cardiac arrests occur outside of the hospital each year in the United States. Less than 15 percent of all individuals experiencing a cardiac arrest survive, no matter the location. But if a person is out of the hospital and gets CPR, they have a 45 percent chance of surviving

Strange said, “For every minute without CPR the chance of a person surviving decreases by 20 percent. Even with CPR, the majority of those people won’t survive. However, that small chance is worth the effort.”

A Cleveland Clinic survey showed that only half of Americans say they know how to perform CPR, and only 1 in 6 know that the recommendation is only chest compressions, not rescue breaths.

Despite this, there’s always room to learn.

Learning CPR is simple. The American Heart Association has a one-minute video to teach hands-only CPR.

Out-of-hospital resuscitation using CPR is a challenging but achievable goal. Beginning CPR early can increase a person’s chance of surviving and even having a favorable long-term neurologic recovery. To avoid delaying chest compressions, it’s recommended to avoid rescue breaths between chest compressions.

Friedman recommends that if the person is unresponsive, you should perform CPR until emergency medical services arrives.

“There should be no fears in performing CPR. You’re not going to make them any worse,” Friedman said. “You can only save their life and make them better.”