What hands-only CPR is
Chest compressions with no rescue breaths. For an adult who suddenly collapses, it is the recommended approach for untrained or unpractised bystanders, and it performs comparably to conventional CPR in the first minutes after a witnessed arrest.
The reason it works: at the moment of collapse, there is still oxygen in the blood and lungs. The problem is not a lack of oxygen — it is that nothing is circulating it. Compressions solve the circulation problem.
When to use it
- An adult or teen who collapses suddenly in front of you
- They are unresponsive and not breathing normally
- You are untrained, out of practice, or unwilling to give breaths
When conventional CPR with breaths is better
- Infants and children — paediatric arrests are usually breathing-related, so breaths matter
- Drowning
- Drug overdose
- Any collapse you did not witness, where the person may have been down a while
- Prolonged arrest — once minutes pass, the oxygen in the blood is used up
If you are trained and able, compressions with breaths remain the standard. Hands-only is the version that works when the alternative is nothing.
How to do it
- Check responsiveness. Tap the shoulder and shout. No response, no normal breathing — act. Occasional gasping is not normal breathing; it is a sign of arrest.
- Call 911 or send someone. Put the phone on speaker — the dispatcher can coach you.
- Position your hands. Heel of one hand on the centre of the chest, on the lower half of the breastbone. Other hand on top, fingers interlocked.
- Lock your elbows and get your shoulders directly over your hands. Push from your hips, not your arms.
- Push hard and fast. At least 2 inches deep, 100 to 120 compressions per minute.
- Let the chest recoil fully between compressions without lifting your hands.
- Do not stop until EMS takes over, an AED arrives, or the person starts breathing normally.
100–120 beats per minute is roughly the tempo of "Stayin' Alive." Any steady song at that pace works — the point is a metronome in your head so you do not drift slow under stress.
The mistakes that matter
- Too shallow. Most people under-compress. Two inches is deeper than it feels.
- Too slow. Fatigue drags the rate down within two minutes. Swap rescuers every two minutes if someone else is there.
- Leaning on the chest. Incomplete recoil stops the heart refilling. Release fully every time.
- Long pauses. Every interruption drops blood pressure. Minimise time off the chest.
- Waiting to be sure. Hesitating to confirm the person is really in arrest costs the minutes that decide the outcome.
"What if I break a rib?"
Rib fractures happen, particularly in older adults. They heal. A person in cardiac arrest who receives no compressions does not. If you are compressing deeply enough to be effective, you are doing it right — and Wisconsin, like every state, has Good Samaritan protections for people acting in good faith in an emergency.
Get the AED too
Hands-only CPR sustains circulation; it rarely restarts a heart. If there is an AED nearby, send someone for it while you keep compressing. Compressions plus early defibrillation is the combination that changes outcomes — see CPR vs AED for how the two fit together.
Bottom line
Adult collapses, unresponsive, not breathing normally: call 911, push hard and fast in the centre of the chest at 100–120 per minute, let the chest come all the way back up, and do not stop. It is the version of CPR that gets used, because it is the version people are willing to start.
Twenty minutes of practice on a manikin makes the difference between knowing this and doing it. Our Heartsaver CPR & AED course covers hands-only and conventional CPR for all ages.
Get certified in Madison
AHA-aligned CPR, AED and First Aid courses. Classroom $99, blended $89, two-year certification.