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How to Perform Cardiopulmonary Resuscitation (CPR)

What is cardiopulmonary resuscitation (CPR)?

CPR is a lifesaving technique. It aims to keep the blood and oxygen flowing through a person’s body when their heartbeat and breathing have stopped. If you perform CPR within the first six minutes after a person’s heart stops, it can potentially keep them alive until medical help arrives.

Any trained person can perform CPR. It involves external chest compressions and rescue breathing. While there’s no substitute for getting formal CPR training from a certified instructor, you can still help someone whose breathing and heartbeat have stopped if you haven’t had formal training.

The American Heart Association (AHA) recommends that bystanders who haven’t received CPR training contact emergency services and initiate hands-only CPR, without rescue breathing. This method is easy to perform, it’s better than simply waiting for trained help to arrive, and it can potentially save lives.

Steps for hands-only CPR

1. Survey the scene

Before you approach someone who’s collapsed, check for hazards that could potentially hurt you. Make sure it’s safe for you to reach the victim. For example, look for fallen power lines, smoke, or other signs of danger.

2. Check the person for responsiveness

Shake the person’s shoulder and loudly ask them "Are you OK?" If they’re an infant, tap the bottom of their foot and check for a reaction.

3. Contact emergency services

If the person doesn’t respond, call 911 or your local emergency services. You can also ask someone else to call.

Begin CPR first if you’re alone and you suspect the person is a child or victim of drowning. Perform it for two minutes, and then call 911.

4. Check their heart with an automated external defibrillator (AED)

If an AED is available, use this device to check the person’s heart rhythm. Some malls, gyms, and other centers keep an AED on site. This portable electronic device can automatically detect abnormalities in a person’s heart rhythm. If needed, it also delivers an electric shock to their chest to restore their normal heart rhythm.

This process is called defibrillation. According to the AHA, most sudden cardiac arrests are caused by a fast and irregular heart rhythm that begins in the lower chambers, or ventricles, of someone’s heart. This is called ventricular fibrillation. An AED can help restore their heart’s normal rhythm and even revive someone whose heart has stopped functioning.

If the AED instructs you to do so, deliver one electric shock to the person’s heart before you begin chest compressions. If the person appears to be a child between the ages of 1 and 8 years old, perform chest compressions for two minutes before checking their heart with an AED. You should also use pediatric pads with the AED if they’re available. Don’t use an AED if the person appears to be an infant under the age of 1 year old.

If an AED isn’t immediately available, don’t waste time looking for the device. Start chest compressions immediately.

5. Position your hand on their chest

If the person looks older than 8 years of age, place the heel of one of your hands on the center of their chest, between their nipples. Place your other hand on top of your first hand and interlock your fingers. You should draw your fingers upward and the heel of your bottom hand should be flat on the person’s chest.

If the person is a child who appears to be between 1 and 8 years old, place only one of your hands on the center of their chest between their nipples. For younger infants, place two of your fingers on the center of their chest, slightly below their nipple line.

6. Begin compressions

If the person appears to be older than 8 years old, use your upper body to push straight down on their chest to compress it by at least 2 inches. Deliver compressions at a rate of 100 compressions per minute. Allow their chest to recoil between compressions.

If they appear to be a child between the ages of 1 to 8 years old, push straight down on their chest to compress it by about 2 inches, at a rate of 100 compressions per minute. Allow their chest to recoil between compressions. For younger infants, push straight down to compress their chest by about 1 1/2 inches, at a rate of 100 compressions per minute. Again, let their chest recoil between compressions.

7. Continue compressions

Repeat the compression cycle until the person starts to breathe or medical help arrives. If they begin to breathe, help them lie on their side quietly while you wait for medical help.

Steps for mouth-to-mouth resuscitation

In 2010, the AHA revised its guidelines for CPR with mouth-to-mouth resuscitation. According to the updated guidelines, you should start chest compressions first before opening the person’s airway.

The new acronym CAB stands for compressions, airway, and breathing. It’s replaced the acronym ABC, which stood for airway, breathing, and compressions. In the first few minutes after someone’s heart stops beating, oxygen remains in their lungs and bloodstream. Starting chest compressions immediately can help send this critical oxygen to their brain and heart without delay.

If you’re trained in CPR and come across someone who’s unresponsive or not breathing do the following:

1. Perform hands-only CPR

Follow the steps for hands-only CPR for 30 chest compressions.

2. Open their airway

Then, start to perform the steps for CPR with mouth-to-mouth breathing.

Put the palm of your hand on the person’s forehead. Gently tilt their head back. Lift their chin forward with your other hand. If the person is a small child or infant, a head tilt alone will often open their airway.

3. Give rescue breaths

If the person appears to be older than 1 year of age, pinch their nostrils shut and cover their mouth with a CPR facemask to make a seal. If they look younger than 1 year of age, cover both their mouth and nose with the mask. Some masks are big enough to cover the nose and mouth of older children and adults too. If a mask isn’t available, cover the person’s mouth with your own.

Give two rescue breaths, exhaling for about one second each. Watch for their chest to rise with each breath. If it doesn’t rise, reposition the facemask and try again.

4. Alternate rescue breathing with chest compressions

Continue alternating 30 chest compressions with two rescue breaths until the person begins to breathe or medical help arrives. If they begin to breathe, help them lie on their side quietly while you wait for medical assistance.

CPR and AED training

The AHA, American Red Cross, and many other agencies offer CPR training. Many agencies also offer training to help you learn how to use an AED. When used properly with CPR, an AED greatly increases a victim’s chances for survival.

To learn about opportunities for CPR and AED training in your area, contact the AHA, American Red Cross, or local first-aid organizations. This training could potentially help you save someone’s life.

Content licensed from:

Written by: Linda Hepler, RN
Medically reviewed on: May 24, 2016: Deborah Weatherspoon, Ph.D, MSN, RN, CRNA

This feature is for informational purposes only and should not be used to replace the care and information received from your health care provider. Please consult a health care professional with any health concerns you may have.
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