Cardiopulmonary resuscitation (CPR) can save a life in the event of a cardiac emergency, but very few people know how to perform CPR correctly. If you see someone collapse and become unconscious with no signs of breathing, they are likely experiencing cardiac arrest. When that occurs, you need to act immediately.
The good news is that anyone can perform CPR; you just need to understand the steps involved. First, you need to check for responsiveness. Then, if the patient is indeed unresponsive, you move on to performing chest compressions and (in some cases) rescue breathing.
1. Check for Responsiveness
You never want to perform CPR on someone who is breathing. You should only do it on someone with no heartbeat or pulse. Since checking for a pulse can be difficult and time-consuming for the untrained layperson (and time is not on your side), you want to check for breathing instead.
- Start with the “shake and shout” method. Shake the victim and shout their name, studying for any type of responsiveness. If they respond with voluntary words, movements, or gestures, do not perform CPR. If they remain unresponsive, proceed to the next steps.
- Send someone to call 9-1-1 immediately. If an AED is available, have someone bring it over to you. Many schools, offices, and other public locations keep defibrillators on hand as part of an emergency preparedness plan—or as required by law in certain states.
- Assess the patient for breathing. To do this, kneel over the patient and scan between the chest and mouth/nose, looking primarily for chest rise and fall but also for air movement out of the nose and mouth. If the patient is either not breathing or only gasping (agonal respirations), then—and only then—begin CPR.
To administer CPR successfully, you just need to remember the acronym CAB: Compressions, Airway, Breathing.
Chest compressions should always come first. They allow you to keep the patient’s blood circulating while you wait for a defibrillator to arrive. Without constant blood circulation, the patient’s organs will fail within minutes.
- Kneel beside the patient and roll them onto their back if they’re not already positioned accordingly.
- Expose the person’s bare chest. Do not attempt to perform CPR over their clothing.
- Place your hands flat on the center of the person’s chest.
- Push straight down in consistent, repetitive motions—you want to push down to a depth of no less than 2 inches but no more than 2.4 inches (between 5 and 6 centimeters). Maintain a pace of 100 to 120 beats per minute. One easy method is to apply compressions to the beat of the Bee Gees’ Stayin’ Alive.
- Allow the chest to return to its original position between compressions.
If you have experience and training in cardiopulmonary resuscitation, perform at least 30 compressions before proceeding to the next step in the process. If you don’t have CPR training, continue with these compressions until emergency services arrive. Do not proceed to the next step.
If you’ve already had some basic training in cardiopulmonary resuscitation, the next step is to open the patient’s airway using the head-tilt, chin-lift technique.
- Place the palm of your hand on the patient’s forehead and gently tilt the head back.
- Use your free hand to lift the chin forward and up, opening the airway.
- Apply only gentle pressure, and don’t try to force the airway open. If it won’t open, you can still breathe into the patient’s nose rather than the mouth.
The final step is to apply rescue breathing, in which you breathe on the victim’s behalf. The airway and breathing processes aren’t always essential to successful cardiopulmonary resuscitation, but CPR certification still requires these skills. That’s because CPR with rescue breathing can be more effective, especially in certain circumstances.
For instance, if the victim has been unconscious for an unknown period of time, rescue breathing may be essential. It’s also recommended if the cardiac arrest is due to respiratory failure.
- Pinch the person’s nose while continuing to hold their airway open.
- Cover the person’s mouth with your own, establishing an airtight seal.
- Breathe once into the person’s airway for one full second, and wait for the chest to rise.
3.1 If the chest rises, breathe into the airway a second time.
3.2 If the chest does not rise, repeat the full Airway process above and then apply the second breath.
- Apply 30 more compressions.
Thirty compressions and two rescue breaths complete one full CPR cycle. Continue alternating between compressions and breaths for 5 full cycles (or about 2 minutes) before reassesing the patient. Reassesment consists of checking the patient again for a brief 5-10 seconds for any signs of breathing or movement. If no change has occurred continue CPR for another 5 cycles (about 2 minutes) before reassesing again, continuing this routine until an AED arrives, the patient regains consciousness, or emergency professionals arrive.
Special Considerations for Children & Infants
About 7,000 children a year experience cardiac arrest. When this happens, the CPR process can be a bit different.
For infants (4 weeks to a year old): Most cardiac arrests in infants are caused by airway obstructions. Before performing cardiopulmonary resuscitation, consider first aid for choking if the infant is conscious. If the baby becomes unresponsive, begin CPR. Compress the chest no more than 1.5 inches or 4 centimeters (as opposed to the 2 to 2.4 inches required for older patients). When administering rescue breaths, use gentle breathing rather than deep breaths, just enough to make the infants chest rise, but not their abdomen. If you did not see the baby collapse, perform five cycles of 30 compressions and 2 breaths immediately. Then call 9-1-1 if the infant remains unresponsive. Continue CPR until the baby recovers or medical services arrive. If you did see the baby collapse, call 911 first.
For children (age 1 through adolescence): The process for children is virtually the same as for adults, but with one major distinction. As with infants, you’ll want to watch the depth of your chest compressions. Adolescents can be compressed to the full depth of 2.4 inches (6 centimeters), but smaller children should only be compressed to 2 inches (5 centimeters).
If a Defibrillator Is Available
The purpose of cardiopulmonary resuscitation is to keep the blood circulating until the heart starts again. In cases of cardiac arrest, an electric shock from an automated external defibrillator (AED) is usually required to get the heart pumping again. That’s why you need to keep performing CPR until emergency services arrive.
If an AED is nearby, perform the CPR steps above while someone retrieves the defibrillator. Once you have the defibrillator in hand, proceed with the following:
- Turn on the defibrillation device. There should be a Power button.
- Attach the defibrillator pads to the patient’s bare chest. Refer to the back of each pad for exact placement instructions.
- Follow the audible or visible instructions provided by the defibrillator. If the AED prompts you to deliver a shock, do so by pressing the shock button, or by standing clear if the AED is a fully automatic version. If the AED prompts that no shock is advised, then continue CPR, leaving the defibrillator on with pads attached.
A few quick warnings:
- Do not place defibrillator pads over a pacemaker. You should notice a large, round protrusion near the left collarbone. If a pacemaker is present, place the pad at least one inch away from it or wait for emergency services to arrive.
- Do not place a defibrillator directly over a medicine patch. Remove the patch before proceeding.
- Do not place a defibrillator over an excessively hairy chest. If possible, find a way to shave the chest area first, or wait for emergency services to arrive.
- Do not attempt to use a defibrillator on a patient who is wet or submerged in water. Make sure they’re completely dry before you apply shock.
- If you’re using an AED on a child, first check to see if pediatric pads are available. Some automated external defibrillators, like the ZOLL AED Plus, offer separate pads for adults and children. Other models, like the Physio-Control LIFEPAK CR2, will instead include a Child Mode button, which adjusts the level of shock based on the patient’s age. When possible, pediatric pads or settings should always be used on children under 8 years old or 55 pounds.
Cardiopulmonary Resuscitation Saves Lives
The information in this article is intended to assist you in the event of an emergency. However, there is no substitute for formal, professional training in cardiopulmonary resuscitation. To best prepare yourself for unexpected cardiac emergencies, consider taking a licensed course and earning a CPR certification. This will equip you with the knowledge and hands-on experience to confidently take the lead when the unthinkable happens. It’s also a good idea to keep an AED on hand, as it will allow you to save precious minutes and take lifesaving action before emergency services arrive.
A cardiac event can happen to anybody at any time. You have the power to prevent an emergency from becoming a tragedy.