CPR 'hands-only' guidelines may not be best for rural areas

New guidelines released by the American Heart Association in 2010 permit the use of simpler hand-only or compression-only CPR in some cases instead of conventional CPR. If ambulances come quickly, experts believe that instructing people to just "push hard, push fast" saves more lives.

But a literature review by Dr. Aaron Orkin found little evidence to support those guidelines outside of urban settings or in communities with no 911 services. His findings were published in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.

Of the 10 studies on saving lives with hands-only CPR he reviewed, only one included rural populations and people who had to wait longer than 15 minutes for an ambulance. Some of those studies showed that people who waited longer for ambulances to arrive had a better chance of surviving if mouth-to-mouth breathing was performed as well as chest compressions.

"Urban studies can't always be applied outside big cities," said Dr. Orkin, a physician and graduate student affiliated with the University of Toronto, the Northern Ontario School of Medicine and Rescu, a St. Michael's Hospital research team dedicated to improving out-of-hospital resuscitation.

"Rural communities might need different CPR recommendations to urban settings," he said.

Dr. Orkin said he study suggests that "push hard, push fast" might be better refined to "push hard, push fast, if you're downtown."

One in five Canadians and nearly half of the world's population live in rural areas. Even in the most developed and densely populated cities, people can wait longer than 10 or 15 minutes for ambulance services

"If someone is unresponsive, doing any kind of CPR is clearly better than doing nothing," said Dr. Orkin. "But shouldn't CPR guidelines serve everybody, not just people who live a few minutes from an ambulance dispatch station or hospital?