How to do CPR

It's far better to do something than to do nothing at all if you're fearful that your knowledge or abilities aren't 100 percent complete. Remember, the difference between your doing something and doing nothing could be someone's life.

Here's advice from the American Heart Association:

Untrained. If you're not trained in CPR, then provide hands-only CPR. That means uninterrupted chest compressions of 100 to 120 a minute until paramedics arrive (described in more detail below). You don't need to try rescue breathing.

Trained and ready to go. If you're well-trained and confident in your ability, check to see if there is a pulse and breathing. If there is no breathing or a pulse within 10 seconds, begin chest compressions. Start CPR with 30 chest compressions before giving two rescue breaths.

Trained but rusty. If you've previously received CPR training but you're not confident in your abilities, then just do chest compressions at a rate of 100 to 120 a minute. (Details described below.)

The above advice applies to adults, children and infants needing CPR, but not newborns (infants up to 4 weeks old).

CPR can keep oxygenated blood flowing to the brain and other vital organs until more definitive medical treatment can restore a normal heart rhythm.

When the heart stops, the lack of oxygenated blood can cause brain damage in only a few minutes. A person may die within eight to 10 minutes.

To learn CPR properly, take an accredited first-aid training course, including CPR and how to use an automated external defibrillator (AED). If you are untrained and have immediate access to a phone, call 911 or your local emergency number before beginning CPR. The dispatcher can instruct you in the proper procedures until help arrives.

Before you begin

Before starting CPR, check:

Is the environment safe for the person?

Is the person conscious or unconscious?

If the person appears unconscious, tap or shake his or her shoulder and ask loudly, "Are you OK?"

If the person doesn't respond and two people are available, have one person call 911 or the local emergency number and get the AED, if one is available, and have the other person begin CPR.

If you are alone and have immediate access to a telephone, call 911 or your local emergency number before beginning CPR. Get the AED, if one is available.

As soon as an AED is available, deliver one shock if instructed by the device, then begin CPR.

Remember to spell C-A-B

Chest compressions Open pop-up dialog box

Chest compressions

Airway being opened Open pop-up dialog box

Open the airway

Rescue breathing Open pop-up dialog box

Rescue breathing

The American Heart Association uses the letters C-A-B — compressions, airway, breathing — to help people remember the order to perform the steps of CPR.

Compressions: Restore blood circulation

Put the person on his or her back on a firm surface.

Kneel next to the person's neck and shoulders.

Place the heel of one hand over the center of the person's chest, between the nipples. Place your other hand on top of the first hand. Keep your elbows straight and position your shoulders directly above your hands.

Use your upper body weight (not just your arms) as you push straight down on (compress) the chest at least 2 inches (approximately 5 centimeters) but not greater than 2.4 inches (approximately 6 centimeters). Push hard at a rate of 100 to 120 compressions a minute.

If you haven't been trained in CPR, continue chest compressions until there are signs of movement or until emergency medical personnel take over. If you have been trained in CPR, go on to opening the airway and rescue breathing.

Airway: Open the airway

If you're trained in CPR and you've performed 30 chest compressions, open the person's airway using the head-tilt, chin-lift maneuver. Put your palm on the person's forehead and gently tilt the head back. Then with the other hand, gently lift the chin forward to open the airway.

Breathing: Breathe for the person

Rescue breathing can be mouth-to-mouth breathing or mouth-to-nose breathing if the mouth is seriously injured or can't be opened.

With the airway open (using the head-tilt, chin-lift maneuver), pinch the nostrils shut for mouth-to-mouth breathing and cover the person's mouth with yours, making a seal.

Prepare to give two rescue breaths. Give the first rescue breath — lasting one second — and watch to see if the chest rises. If it does rise, give the second breath. If the chest doesn't rise, repeat the head-tilt, chin-lift maneuver and then give the second breath. Thirty chest compressions followed by two rescue breaths is considered one cycle. Be careful not to provide too many breaths or to breathe with too much force.

Resume chest compressions to restore circulation.

As soon as an automated external defibrillator (AED) is available, apply it and follow the prompts. Administer one shock, then resume CPR — starting with chest compressions — for two more minutes before administering a second shock. If you're not trained to use an AED, a 911 or other emergency medical operator may be able to guide you in its use. If an AED isn't available, go to step 5 below.

Continue CPR until there are signs of movement or emergency medical personnel take over.

To perform CPR on a child

The procedure for giving CPR to a child age 1 through puberty is essentially the same as that for an adult. The American Heart Association also recommends the following to perform CPR on a child:

Compressions: Restore blood circulation

If you are alone and didn't see the child collapse, perform five cycles of compressions and breaths on the child — this should take about two minutes — before calling 911 or your local emergency number and getting the AED, if one is available.

If you're alone and you did see the child collapse, call 911 or your local emergency number and get the AED, if one is available, before beginning CPR. If another person is available, have that person call for help and get the AED while you begin CPR.

Put the child on his or her back on a firm surface.

Kneel next to the child's neck and shoulders.

Use two hands, or only one hand if the child is very small, to perform chest compressions. Press straight down on (compress) the chest about 2 inches (approximately 5 centimeters). If the child is an adolescent, push straight down on the chest at least 2 inches (approximately 5 centimeters) but not greater than 2.4 inches (approximately 6 centimeters). Push hard at a rate of 100 to 120 compressions a minute.

If you haven't been trained in CPR, continue chest compressions until there are signs of movement or until emergency medical personnel take over. If you have been trained in CPR, go on to opening the airway and rescue breathing.

Airway: Open the airway

If you're trained in CPR and you've performed 30 chest compressions, open the child's airway using the head-tilt, chin-lift maneuver. Put your palm on the child's forehead and gently tilt the head back. Then with the other hand, gently lift the chin forward to open the airway.

Breathing: Breathe for the child

Use the same compression-breath rate that is used for adults: 30 compressions followed by two breaths. This is one cycle.

With the airway open (using the head-tilt, chin-lift maneuver), pinch the nostrils shut for mouth-to-mouth breathing and cover the child's mouth with yours, making a seal.

Prepare to give two rescue breaths. Give the first rescue breath — lasting one second — and watch to see if the chest rises. If it does rise, give the second breath. If the chest doesn't rise, repeat the head-tilt, chin-lift maneuver and then give the second breath. Be careful not to provide too many breaths or to breathe with too much force.

After the two breaths, immediately begin the next cycle of compressions and breaths. If there are two people performing CPR, conduct 15 compressions followed by two breaths.

As soon as an AED is available, apply it and follow the prompts. Use pediatric pads if available, for children up to age 8. If pediatric pads aren't available, use adult pads. Administer one shock, then resume CPR — starting with chest compressions — for two more minutes before administering a second shock. If you're not trained to use an AED, a 911 or other emergency medical operator may be able to guide you in its use.

Continue until the child moves or help arrives.

To perform CPR on a baby 4 weeks old and older

Most cardiac arrests in babies occur from lack of oxygen, such as from drowning or choking. If you know the baby has an airway obstruction, perform first aid for choking. If you don't know why the baby isn't breathing, perform CPR.

To begin, examine the situation. Stroke the baby and watch for a response, such as movement, but don't shake the baby.

If there's no response, follow the C-A-B procedures below for a baby under age 1 (except newborns, which includes babies up to 4 weeks old) and time the call for help as follows:

If you're the only rescuer and you didn't see the baby collapse, do CPR for two minutes — about five cycles — before calling 911 or your local emergency number and getting the AED. If you did see the baby collapse, call 911 or your local emergency number and get the AED, if one is available, before beginning CPR.

If another person is available, have that person call for help immediately and get the AED while you attend to the baby.

Compressions: Restore blood circulation

Place the baby on his or her back on a firm, flat surface, such as a table. The floor or ground also will do.

Imagine a horizontal line drawn between the baby's nipples. Place two fingers of one hand just below this line, in the center of the chest.

Gently compress the chest about 1.5 inches (about 4 centimeters).

Count aloud as you pump in a fairly rapid rhythm. You should pump at a rate of 100 to 120 compressions a minute.

Airway: Open the airway

After 30 compressions, gently tip the head back by lifting the chin with one hand and pushing down on the forehead with the other hand.

Breathing: Breathe for the baby

Cover the baby's mouth and nose with your mouth.

Prepare to give two rescue breaths. Use the strength of your cheeks to deliver gentle puffs of air (instead of deep breaths from your lungs) to slowly breathe into the baby's mouth one time, taking one second for the breath. Watch to see if the baby's chest rises. If it does, give a second rescue breath. If the chest does not rise, repeat the head-tilt, chin-lift maneuver and then give the second breath.

If the baby's chest still doesn't rise, continue chest compressions.

Give two breaths after every 30 chest compressions. If two people are conducting CPR, give two breaths after every 15 chest compressions.

Perform CPR for about two minutes before calling for help unless someone else can make the call while you attend to the infant.

Continue CPR until you see signs of life or until medical personnel arrive.

Cardiopulmonary resuscitation (CPR) is an emergency procedure that can help save a person's life if their breathing or heart stops. When a person's heart stops beating, they are in cardiac arrest. ... CPR uses chest compressions to mimic how the heart pumps. These compressions help keep blood flowing throughout the body.

Cardiopulmonary resuscitation (CPR) is an emergency procedure that can help save a person's life if their breathing or heart stops. When a person's heart stops beating, they are in cardiac arrest. ... CPR uses chest compressions to mimic how the heart pumps. These compressions help keep blood flowing throughout the body.

Cardiopulmonary resuscitation (CPR) is an emergency procedure that combines chest compressions often with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest. It is recommended in those who are unresponsive with no breathing or abnormal breathing, for example, agonal respirations.

CPR involves chest compressions for adults between 5 cm (2.0 in) and 6 cm (2.4 in) deep and at a rate of at least 100 to 120 per minute. The rescuer may also provide artificial ventilation by either exhaling air into the subject's mouth or nose (mouth-to-mouth resuscitation) or using a device that pushes air into the subject's lungs (mechanical ventilation). Current recommendations place emphasis on early and high-quality chest compressions over artificial ventilation; a simplified CPR method involving chest compressions, is only recommended for untrained rescuers. In children, however, only doing compressions may result in worse outcomes because, in children, the problem normally arises from a respiratory, rather than cardiac, problem.[1] Chest compression to breathing ratios is set at 30 to 2 in adults.

CPR alone is unlikely to restart the heart. Its main purpose is to restore partial flow of oxygenated blood to the brain and heart. The objective is to delay tissue death and to extend the brief window of opportunity for a successful resuscitation without permanent brain damage. Administration of an electric shock to the subject's heart, termed defibrillation, is usually needed in order to restore a viable, or "perfusing", heart rhythm. Defibrillation is effective only for certain heart rhythms, namely ventricular fibrillation or pulseless ventricular tachycardia, rather than asystole or pulseless electrical activity. Early shock, when appropriate, is recommended. CPR may succeed in inducing a heart rhythm that may be shockable. In general, CPR is continued until the person has a return of spontaneous circulation (ROSC) or is declared dead.

Medical uses

Chest compressions at 100 - 120 per minute on a dummy.

CPR is indicated for any person unresponsive with no breathing or breathing only in occasional agonal gasps, as it is most likely that they are in cardiac arrest. If a person still has a pulse but is not breathing (respiratory arrest) artificial ventilations may be more appropriate, but, due to the difficulty people have in accurately assessing the presence or absence of a pulse, CPR guidelines recommend that lay persons should not be instructed to check the pulse, while giving healthcare professionals the option to check a pulse. In those with cardiac arrest due to trauma, CPR is considered futile but still recommended. Correcting the underlying cause such as a tension pneumothorax or pericardial tamponade may help.

Effectiveness

CPR oxygenates the body and brain for defibrillation and advanced life support. Even in the case of a "non-shockable" rhythm, such as pulseless electrical activity (PEA) where defibrillation is not indicated, effective CPR is no less important. Used alone, CPR will result in few complete recoveries, though the outcome without CPR is almost uniformly fatal.

Studies have shown that immediate CPR followed by defibrillation within 3–5 minutes of sudden VF cardiac arrest dramatically improves survival. In cities such as Seattle where CPR training is widespread and defibrillation by EMS personnel follows quickly, the survival rate is about 20 percent for all causes and as high as 57 percent if a witnessed "shockable" arrest. In cities such as New York, without those advantages, the survival rate is only 5 percent for witnessed shockable arrest.

Similarly in-hospital CPR is more successful when arrests are witnessed or are in the ICU or in patients wearing heart monitors, where the arrests are noticed immediately.

Compression-only CPR may be less effective in children than in adults, as cardiac arrest in children is more likely to have a non-cardiac cause. In a 2010 prospective study of cardiac arrest in children (age 1–17) for arrests with a non-cardiac cause, provision by bystanders of conventional CPR with rescue breathing yielded a favorable neurological outcome at one month more often than did compression-only CPR . For arrests with a cardiac cause in this cohort, there was no difference between the two techniques . This is consistent with American Heart Association guidelines for parents.

When done by trained responders, 30 compressions interrupted by two breaths appears to have a slightly better result than continuous chest compressions with breaths being delivered while compressions are ongoing.

There is a higher proportion of patients who achieve spontaneous circulation (ROSC), where their heart starts beating on its own again, than ultimately survive to be discharged from hospital (see table above).

Measurement of end-tidal carbon dioxide during CPR reflects cardiac output and can predict chances of ROSC.

59% of CPR survivors lived over a year; 44% lived over 3 years, based on a study of CPR done in 2000–2008.

Consequences.

Performing CPR is advised as a last resort intervention, for when a person is not breathing and therefore would certainly die without it.

Survival rates: In US hospitals in 2017, 26% of patients who received CPR survived to hospital discharge. In 2017 in the US, outside hospitals, 16% of people whose cardiac arrest was witnessed survived to hospital discharge.

Since 2003, widespread cooling of patients after CPR and other improvements have raised survival and reduced mental disabilities.

Organ donation.

Organ donation is usually made possible by CPR, even if CPR does not save the patient. If there is a Return of spontaneous circulation (ROSC), all organs can be considered for donation. If the patient does not achieve ROSC, and CPR continues until an operating room is available, the kidneys and liver can still be considered for donation. 1,000 organs per year in the US are transplanted from patients who had CPR.  Donations can be taken from 40% of patients who have ROSC and later become brain dead. Up to 8 organs can be taken from each donor,  and an average of 3 organs are taken from each patient who donates organs.

Mental abilities.

Mental abilities are about the same for survivors before and after CPR for 89% of patients, based on before and after counts of 12,500 US patients' Cerebral-Performance Category ( codes in a 2000-2009 study of CPR in hospitals. 1% more survivors were in comas than before CPR. 5% more needed help with daily activities. 5% more had moderate mental problems and could still be independent.

For CPR outside hospitals, a Copenhagen study of 2,504 patients in 2007-2011 found 21% of survivors developed moderate mental problems but could still be independent, and 11% of survivors developed severe mental problems, so they needed daily help. Two patients out of 2,504 went into comas (0.1% of patients, or 2 out of 419 survivors, 0.5%), and the study did not track how long the comas lasted.

Most people in comas start to recover in 2–3 weeks. 2018 guidelines on disorders of consciousness say it is no longer appropriate to use the term "permanent vegetative state." Mental abilities can continue to improve in the six months after discharge, and in subsequent years. For long-term problems, brains form new paths to replace damaged areas.

Injuries

Injuries from CPR vary. 87% of patients are not injured by CPR  Overall, injuries are caused in 13% (2009-12 data) of patients, including broken sternum or ribs (9%), lung injuries (3%), and internal bleeding (3%). The internal injuries counted here can include heart contusion, hemopericardium,  upper airway complications, damage to the abdominal viscera − lacerations of the liver and spleen, fat emboli,  complications − pneumothorax, hemothorax, lung contusions. Most injuries did not affect care; only 1% of those given CPR received life-threatening injuries from it.

Broken ribs are present in 3%[  of those who survive to hospital discharge, and 15% of those who die in the hospital, for an average rate of 9% (2009-12 data) to 8% (1997–99). In the 2009-12 study, 20% of survivors were older than 75.A study in the 1990s found 55% of CPR patients who died before discharge had broken ribs, and a study in the 1960s found 97% did; training and experience levels have improved. Lung injuries were caused in 3% of patients and other internal bleeding in 3% (2009–12).

Bones heal in 1–2 months. Training and experience levels have improved since the study in the 1990s which found 55% broken ribs among CPR patients who died before discharge, and the study in the 1960s which found 97%.

The costal cartilage also breaks in an unknown number of additional cases, which can sound like breaking bones.

The type and frequency of injury can be affected by factors such as sex and age. A 1999 Austrian study of CPR on cadavers, using a machine which alternately compressed the chest then pulled it outward, found a higher rate of sternal fractures in female cadavers (9 of 17) than male (2 of 20), and found the risk of rib fractures rose with age, though they did not say how much. Children and infants have a low risk of rib fractures during CPR, with an incidence less than 2%, although, when they do occur, they are usually anterior and multiple.

Where CPR is performed in error by a bystander, on a person not in cardiac arrest, around 2% have injury as a result (although 12% experienced discomfort).

A 2004 overview said, "Chest injury is a price worth paying to achieve optimal efficacy of chest compressions. Cautious or faint-hearted chest compression may save bones in the individual case but not the patient’s life."