Where do you stand on bystander CPR?

Robert H. Shmerling, MD

Senior Faculty Editor, Harvard Health Publishing

Follow me on Twitter @RobShmerling

A recent survey confirmed what many have suspected: if you collapsed, there’s a good chance that the average bystander would not be prepared to perform cardiopulmonary resuscitation (CPR). And if they tried to revive you, there’s an even better chance they wouldn’t do it correctly.

Of course, there is a certain circularity to this — if you don’t know how to perform CPR, or if you know how but aren’t sure you’ll perform it correctly, you’ll be less likely to try.

So why are so few prepared?

The list of reasons is long, including:

  • no prior instruction or certification
  • fear of doing it wrong or being blamed for causing more harm than good
  • waiting for someone else (who “knows what they’re doing”) to do it
  • little faith in the effectiveness of CPR
  • the victim might be sick with something the rescuer could catch
  • the “ick factor,” that is, a potential rescuer is put off by the thought of having mouth-to-mouth contact with a stranger (even though current guidelines do not recommend mouth-to-mouth resuscitation).

A new study suggests there’s room for improvement

A new survey performed by the Cleveland Clinic asked 1,000 people about CPR. It also asked about symptoms of stroke and heart attack, since these are conditions for which bystander help can make a big difference.

The results were disappointing:

  • Only 54% reported knowing how to perform CPR. While this is actually more than I would have predicted, it likely represents an overestimation, since many did not know some of the key details about it (as noted below).
  • Only 17% knew that current recommendations for bystander CPR have eliminated the mouth-to-mouth part; bystander CPR now involves only chest compressions.
  • Only 11% knew the proper rate of chest compressions (100 to 120 per minute). Certain songs can help you pace compressions without counting.
  • Only about a quarter reported having an automated external defibrillator at work.
  • About six in 10 people believed sudden numbness or weakness of the face, arm, or leg were symptoms of heart attack (when, in fact, those are more commonly symptoms of stroke).
  • Thirty-nine percent thought slurred speech (a symptom of stroke) was a symptom of a heart attack.
  • Less than half knew that back or jaw pain, nausea, and vomiting could represent symptoms of a heart attack.
  • Only about a third of respondents knew that victims of heart attack should chew an aspirin right away (more on that in a moment).

There’s much you can do — and it’s not difficult

Whatever the reasons for these findings, there seems little justification for it. After all, CPR is much easier now that mouth-to-mouth resuscitation is no longer recommended. And while it’s true that many people don’t survive cardiac arrest — the numbers vary by study, but some studies find rates of survival for out-of-hospital cardiac arrest at less than 5% — chances for survival are higher with bystander help. Instructions regarding the appropriate use of CPR and automated external defibrillators (AEDs) are not complicated and are widely available.

But wait, there’s more!

CPR is only one way to help someone with a medical emergency. Some other things you can do to help include:

  • Try to rouse the person.
  • Check for a pulse and whether the person is breathing.
  • Call 911 — in most cases, this is the very first thing you should do.
  • If heart attack is suspected, instruct the person to chew one full strength or three baby aspirin (total of about 325 mg) over 30 seconds; people with heart disease should be carrying aspirin with them.
  • Instruct others to find the nearest AED. Don’t be afraid to use it — they are designed to be used by anyone.
  • Calling for help, providing reassurance, and staying with a person in need can make a big difference to someone who is critically ill and frightened.

What now?

If you never learned to perform CPR, maybe now is the time. Some of the biggest obstacles (such as having to perform mouth-to-mouth resuscitation) have been removed. So, admit it — you’re running out of excuses! Learn CPR. You could save a life. And even if you never have the opportunity to perform CPR, at least you’ll be ready to try.

Related Information: Harvard Heart Letter


  1. azure

    I’ve found one free class in doing CPR where I live. One in over 10 years. That was 2 years ago and I no longer feel that I remember enough to do it properly. I would gladly attend a free class once a year on doing CPR and other first aid if it were offered in my community. Every 6 months would be even better. Then I would that I had a reasonably good idea of how to perform CPR and other simple first aid.

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