Making CPR More Accessible: Part 1

Today, there’s no shortage of courses available for anyone interested in learning cardiopulmonary resuscitation (CPR). If you’re a student, employee, or expecting parent, training may already be offered at your school, workplace, hospital, or birthing center. If one of those options isn’t readily available, it’s often as easy as looking up local, virtual, or blended learning courses through organizations like the American Heart Association (AHA) and the American Red Cross, or even simply viewing a 1-minute demo video on how to perform hands-only CPR as a starting point.¹ And even if you’ve had no prior CPR training but find yourself witness to a cardiac arrest, you can quickly get 911 on the phone and have an operator walk you through CPR until paramedics arrive.

And while that level of public accessibility and involvement may seem fairly commonplace today, the reality is that we’ve come a long way in our thinking about CPR since it was first introduced in the 1960s. CPR was initially thought of as a skill that was best left in the capable hands of trained medical professionals only, and experts cautioned against its use by members of the general public.^2,3

Clearly, that perspective has shifted significantly over time, through a combination of necessity (cardiac arrest can happen anywhere, and clinicians aren’t always conveniently located nearby when it does), and advancements in technology, techniques, and education.^4,5

Of course, when it comes to rates of bystander CPR and public awareness of cardiac arrest, there’s still plenty of progress to be made — a topic we’ll tackle in part 2 of this series on increasing CPR accessibility. But for now, let’s take a closer look at why and how CPR went from a specialized medical skill to one that could — and should — be taught to and mastered by members of the general public.

Increased awareness of the importance of early CPR

A quick history lesson: Origins of CPR

Modern-day CPR has its roots in the early 1960s, when pioneers in the resuscitation field paired mouth-to-mouth breathing with chest compressions as a temporary, lifesaving measure to provide circulation to victims of cardiac arrest. CPR was officially endorsed by the AHA in 1963.⁴ At the time, the techniques used were still relatively new, so it’s not surprising that experts in the field were wary of encouraging anyone but trained medical professionals to use them. In statements issued in 1962 and 1965, the AHA discussed the “possible dangers of indiscriminate use of CPR” and emphasized the hazards of laypeople performing CPR: damage to the heart and liver, internal bleeding, and rib fractures, to name a few.^2,3

Expansion of CPR to the general public

Of course, here’s what we know now, and what we quickly learned over time: The risk of inaction far outweighs the risk of imperfectly implemented CPR. Approximately 70% of cardiac arrests occur outside a hospital setting, and — if performed on the spot — CPR can double or even triple a victim’s odds of survival.⁶ Early CPR is one of six key links in the AHA’s Chain of Survival, and when the arrest happens outside of a hospital setting — as it often does — that step typically falls to bystanders who witness the event. The vast majority of those bystanders will not have had the benefit of years of medical training, but their willingness to step up and take lifesaving action is absolutely essential. Victims need help immediately when the event occurs, so waiting until paramedics arrive can be costly.

As medical experts and researchers became more knowledgeable about the importance of timely intervention in cardiac arrest, efforts to involve and educate laypeople increased significantly.^4,7 From public campaigns, to hands-only community trainings and online courses, to education about the difference between symptoms of cardiac arrest versus heart attack, there have since been countless initiatives to bring public awareness to cardiac arrest and encourage laypeople to act in an emergency.

Simplified CPR techniques

As we’ve seen, the process of performing CPR was historically considered so complex and daunting that laypeople feared they would harm the victim in the process — and potentially face legal action as a result.

Those fears haven’t been completely extinguished, of course, but they are certainly less prevalent today. In part, that’s because the techniques themselves have been simplified, enabling laypeople to deliver highly effective compressions even without formal training or certification.

One especially significant development in this area is the increased emphasis on compression-only CPR, which eliminates the need for rescue breaths in many scenarios. Not only does hands-only CPR remove the deterrent of having to perform mouth-to-mouth resuscitation on a stranger, it’s also been shown to be as effective as CPR with mouth-to-mouth breaths in those critical first few minutes of an out-of-hospital cardiac arrest.¹

Take the AHA’s “hands-only CPR” campaign, for instance. It’s a powerful example of how a process that was once considered so technical that it was reserved for medical professionals has now been simplified to 2 lifesaving steps that anyone can take: 1) call emergency response, and 2) push hard and fast in the center of the victim’s chest.

Integration of CPR training into schools and workplaces

Alongside increasing awareness of bystander CPR and the simplified techniques to make it possible, integration of CPR training into schools, universities, and workplaces has been another critical step in improving the accessibility of CPR.⁸

The importance of school and workplace training is twofold. To start, cardiac arrest can happen anywhere — including any of these locations — so it certainly helps to be prepared. Making CPR training a standard part of educational and occupational setups helps communities become better prepared to respond to emergencies collectively.⁹ But on top of that, integrating CPR training into these places is an effective strategy to reach as many people as possible.

There’s still room for improvement, of course. Trainings are optional and not available at all institutions, and the US has stopped short of approaches that other countries have adopted—such as making CPR training mandatory to obtain a driver’s license—that go even further to increase reach.¹⁰ Regardless, the progress that has been made is still noteworthy. Many institutions have integrated CPR education into their curricula or offered optional training programs, equipping students and employees with valuable lifesaving skills.

The bottom line

As these examples show, we’ve come a long way in recognizing the importance of bystander CPR and making these lifesaving techniques more accessible to the public.

Of course, there’s still plenty of work to be done. Bystanders still feel powerless to act far too often in a cardiac arrest emergency. In fact, approximately half of Americans would be reluctant to step in and perform CPR, according to a recent survey from the AHA.

So where do we go from here? What will be included in the next round of advancement and innovation that will help encourage even more widespread participation? Stay tuned for part 2 of our series, where we’ll explore the role of technological advances in increasing bystander participation in CPR.