Stayin' Alive with Hands‐Only™ CPR

Need to give CPR? Access your inner disco queen.

Hard and fast: That's the rule to remember when compressing the chest during cardiopulmonary resuscitation (CPR). How hard? The American Heart Association (AHA) recommends pressing to a depth of at least two inches for adults and children, or 1½ inches for infants. How fast? At least 100 times per minute–which just happens to be the beat of the 1977 disco tune by the Bee Gees, “Stayin' Alive.”

Using “Stayin' Alive” as a CPR coach is the brainchild of Alson Inaba, M.D., associate professor of pediatrics at the John Burns School of Medicine, University of Hawaii at Manoa in Honolulu. As a member of the AHA's Program Administrative Committee in 2005, Inaba was one of the experts who reviewed the guidelines for administering CPR for pediatric cardiac arrest before their release to the public. The guidelines emphasized that the optimal rate for chest compressions was 100 times per minute or more. “I realized we needed a way of teaching people how to compress at that rate,” he says.

About a year earlier, Inaba recalls, he had been teaching CPR to medical residents in Honolulu. “We'd do a little skit in which someone would collapse on stage and the residents would use an automated external defibrillator (AED) to save the person's life. One of them happened to bring a boom box on stage, and I told him to use the song ‘Stayin Alive’ because the title seemed fitting.” That skit came back to Inaba as he pondered the most effective way to demonstrate the best rhythm for CPR, so he put on a CD of “Stayin' Alive” and simply counted the beats. “I realized that it had a beat of almost exactly 100 times a minute, and I decided that would be how I would teach CPR to my students: I'd play the song and have them do the compressions to that.”

Word of Inaba's unique teaching tool spread. It was featured in the Fall 2006 issue of the AHA publication Currents in Emergency Cardiovascular Care and appeared on the AHA website. The tip went viral faster than you can say John Travolta. “Within a few months I was getting e-mails from people who were using it to save lives in Canada, Egypt, and Australia. I even got a video clip from Botswana, Africa, of the chief executive officer of one of the hospitals there performing compressions on a mannequin with ‘Stayin’ Alive' blaring in the background.”


Despite the clear benefits of CPR, it is seriously under-used. According to research by Bentley Bobrow, M.D., associate professor of emergency medicine at Maricopa Medical Center and Arizona Emergency Medical Research Center in Phoenix, only 30 percent of bystanders attempt CPR when they see someone in cardiac arrest. “Roughly 70 percent of the victims, on average, get nothing,” Bobrow says. “Many lay people are uncertain what to do.”

Even those who know something about CPR may not remember the exact ratio of breaths to compressions or may be afraid of doing more harm than good. Other people may feel uncomfortable making mouth-to-mouth contact with a stranger.

Hands-Only™ (also called compression-only) CPR “may remove many of the barriers to conventional CPR,” Bobrow says. As the name implies, Hands-Only CPR focuses on chest compressions and eliminates the need for mouth-to-mouth breathing. In 2005, concerned about the dismal survival rate of people who experienced out-of-hospital cardiac arrest, the Arizona Department of Health Services launched a statewide effort to encourage more bystanders to perform Hands-Only CPR. Between 2005 and 2009, the proportion of bystanders who attempted CPR increased from 28 percent to nearly 40 percent, and the proportion of rescues that involved Hands-Only CPR jumped from about 20 percent to 76 percent. Most importantly, survival increased from just under 4 percent to nearly 10 percent. Survival was 60 percent more likely with Hands-Only than conventional CPR with breaths and pushes.


One of the advantages of Hands-Only CPR is its simplicity. “If we want bystanders to start doing CPR, we need to make the message as simple as possible,” says Marion Leary, R.N., assistant director of clinical research at the Center for Resuscitation at the Hospital of the University of Pennsylvania in Philadelphia. “There are a lot more steps involved with conventional CPR with breaths and pushes. It's simpler just to say, ‘If you find someone down on the ground without a pulse, just start pushing on his chest as hard and as fast as you can.’”

Hands-Only CPR consists of these steps:

  • Position the person face-up on a hard, flat surface.
  • Place one hand in the center of the victim's chest and interlock the other on top.
  • Start compressing the chest hard and fast. Push to the beat of the Bee Gees song “Stayin' Alive,” and keep that in your mind as you are pushing.
  • Continue until the person begins to breathe or move, or until someone with more advanced training arrives and takes over. “Look for purposeful movement, such as sitting up and talking to you,” Bobrow says. “Moaning and shaking are not purposeful.”

Conventional CPR with breaths is preferable to Hands-Only if possible, says Inaba, “because you do get some ventilation that way. But if an adult collapses in front of you, it might be better just to compress the chest because you saw the person and know they were breathing until the moment they went down. Remember: Each time you interrupt compressions to do ventilation is time you are not pumping blood through the heart.” Conventional CPR is also preferred for infants and children or adults who have collapsed from a respiratory emergency such as choking or drowning.

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