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ystanders who witness the sudden collapse of an adult should activate the emergency medical services (EMS) system and provide high-quality chest compressions by push- ing hard and fast in the middle of the victim's chest, with minimal interruptions. This recommendation is based on evaluation of recent scientific studies and consensus of the American Heart Association Emergency Cardiovascular Care (ECC) Committee. This science advisory is published to amend and clarify the "2005 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC)" for bystanders who witness an adult out-of-hospital sudden cardiac arrest. Ten years ago, the AHA commissioned a working group of resuscitation scientists to reappraise the Association's inclu- sion of ventilations in the recommended sequence for by- stander cardiopulmonary resuscitation (CPR). The working group evaluated peer-reviewed reports of laboratory and human research and summarized their findings in a 1997 statement.1 The key conclusion of that statement was that "Current guidelines for performing mouth-to-mouth ventila- tion during CPR should not be changed at this time."1 In the animal studies cited in the 1997 statement, when ventricular fibrillation arrest was of short (under 6 minutes) duration, the addition of rescue ventilations to chest compres- sions did not improve outcome compared with chest com- pressions alone (LOE 6*).2-8 Analysis of human data from a

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Hands-Only (Compression-Only) Cardiopulmonary Resuscitation: A Call to Action for Bystander Response to Adults Who Experience Out-of-Hospital Sudden Cardiac Arrest