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The Evolution of CPR: Shift from Rescue Breaths to Hands-Only CPR


Created in the 1960s, CPR, or cardiopulmonary resuscitation, is a lifesaving technique that can help keep blood flowing throughout a person’s body in the absence of a normal heart rhythm. CPR involves a series of chest compressions and rescue breaths. A vital link in the chain of survival for Sudden Cardiac Arrest (SCA), CPR helps improve someone’s chances of surviving a dangerous medical emergency. 

If you took a CPR class more than a decade ago, you might be wondering, why is mouth-to-mouth no longer recommended?

The Move to Hands-Only CPR

Is mouth to mouth still recommended

Rescue breaths, often called “mouth-to-mouth”, are a component of CPR where a responder breathes into a person’s mouth to try and deliver oxygen to their lungs. This particular step has led to squeamishness and general hesitation on the part of the untrained or lay rescuer who is, understandably, hesitant to seal another person’s mouth with their lips.

In 2008, after the publication of several studies looking at the rates of bystander CPR and public attitudes toward it, the American Heart Association updated their guidelines and decided to take out rescue breathing as a way to encourage lay responders to focus on Hands-Only CPR. The AHA believed this change would help decrease the barriers people often feel to intervening during time-sensitive emergencies and ultimately save more lives. 

Why the Shift?

Lynn White, a Vice-Chair on the American Red Cross‘ Scientific Advisory Council, provides a bit of context as to why these guidelines have changed, “The Red Cross authors Guidelines for both professional and lay responders. Our Guidelines state that, for adults, compression-only CPR (also known as Hands-Only CPR) may be used as an alternative to traditional CPR (compressions and ventilations) when someone is unwilling or unable to provide ventilations. We make that recommendation because of the importance of time to starting compressions.”

To be clear, trained and certified responders are still taught and encouraged to deliver rescue breaths during CPR to help increase the chances of survival. However, the move toward Hands-Only CPR encourages the public to engage in quick, immediate action as opposed to fumbling, hesitating, or doing nothing.

Rescue Breaths as a Barrier to Care

Whether it be for fear of performing the steps improperly, fear of hurting oneself, or fear of touching a stranger’s lips, studies have shown that a person’s reluctance to give rescue breaths can delay or withhold a rescue attempt altogether. 

“When you have a bystander who is not formally trained in CPR, they are often hesitant to provide rescue breaths to a stranger. We want these individuals to know that doing something is better than doing nothing. These bystanders can call 911, provide chest compressions and send someone to get the AED.”

Lynn White, MS, FAEMS, American Red Cross Scientific Advisory Council

Because mouth-to-mouth involves direct contact with a person’s mouth and respiratory secretions, many people hesitate or even recoil at the thought of giving rescue breaths, especially when the victim is a stranger or someone they do not know. Concerns about the transmission of diseases or illnesses, which are believed to have intensified in the wake of COVID-19, have also been cause for the guidelines to shift. 

The validity of these concerns, especially in this present moment, emphasizes the need for alternative methods like Hands-Only CPR that lower the risk of disease transmission while still providing effective assistance during cardiac emergencies. 

Interrupting the Flow of CPR

CPR with rescue breaths AND chest compressions is more physically exhausting than Hands-Only CPR. Remembering the correct ratio of rescue breaths to chest compressions and how to deliver rescue breaths without losing the tempo of compressions is also more complicated to keep track of than compressions alone. This has forced experts to consider which element of CPR is more important, the chest compressions or the rescue breaths? 

Studies have found that in addition to being less complicated, CPR without rescue breaths may even be more effective than CPR with mouth-to-mouth because continuous chest compressions alone have been shown to sustain blood circulation more effectively for people in cardiac arrest. Stopping chest compressions in order to administer mouth-to-mouth interrupts the assisted flow of blood, posing greater risks to the person—especially in the first few minutes of the cardiac emergency. An emphasis on Hands-Only CPR allows for a person to deliver a greater number of chest compressions with minimal interruptions. 

The Best Way to Save a Life

While CPR will help keep blood flowing throughout a person’s body during cardiac arrest, the only therapy that will restart their heart and save their life is a shock from an Automated External Defibrillator, or AED. 

why is mouth-to-mouth no longer recommended

Regardless of the type of CPR someone gets, studies indicate that the biggest predictor in successful cardiac arrest outcomes is how quickly defibrillation is delivered. In other words, CPR provides more time for the rescuer to successfully use a defibrillator and revive someone in cardiac arrest. 

To align with AHA’s CPR guidelines, the Avive Connect AED analyzes the patient’s heart rhythm, determines whether a shock is recommended, delivers a shock if advised, and provides two minutes of Hands-Only CPR instruction. This user-friendly design encourages the responder to focus on delivering high-quality chest compressions with little to no interruptions. 


Instructor-led CPR and AED training still teaches students how to recognize the signs of a cardiac arrest, deliver effective rescue breaths, and perform high-quality chest compressions. 

At Avive, we believe that CPR and AED training is always a good idea because in the event of SCA, knowing what to do and how to do it quickly can truly be the difference between life and death. Often, the biggest obstacle to surviving a cardiac arrest is time, which underscores the importance of immediate, easy-to-perform action. 

So, regardless of your training level–you can save a life with Hands-Only CPR and an AED. Empower yourself to respond to a cardiac emergency with the latest AED technology and CPR training from a well-regarded source. 

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