Cardiopulmonary resuscitation (CPR) is an emergency procedure performed when the heart stops beating (cardiac arrest). Immediate CPR doubles or triples survival rates. The Chain of Survival — early recognition and activation of emergency response, early high-quality CPR, early defibrillation, and advanced care and post-arrest care — is the framework for improving outcomes.

CPR training demonstrating chest compressions on a mannequin — CPR combines chest compressions and rescue breathing to maintain blood flow and oxygenation during cardiac arrest. Early CPR doubles or triples survival rates. Source: Unsplash.

Recognizing Cardiac Arrest

Cardiac arrest is not the same as a heart attack. Signs: sudden collapse, unresponsiveness (no response to tapping and shouting), no normal breathing (or only gasping — agonal respirations that are ineffective and should be treated as cardiac arrest), and no pulse (lay rescuers are not required to check for a pulse — absence of normal breathing is sufficient to activate CPR). Before approaching: ensure the scene is safe.

Activating Emergency Response

Call 911 immediately (or have someone else call). Put the phone on speaker. The dispatcher can provide CPR instructions. If an automated external defibrillator (AED) is available, have someone retrieve it. Time to defibrillation is the most important determinant of survival — each minute of delay reduces survival by 7–10%.

AED defibrillator device for emergency cardiac care — An automated external defibrillator (AED) can analyze heart rhythm and deliver an electric shock if needed. Source: Unsplash.

Adult CPR — Hands-Only CPR

For untrained bystanders, hands-only CPR (compressions without rescue breaths) is recommended for adult cardiac arrest. Push hard and fast in the center of the chest: push at a rate of 100–120 compressions per minute (to the beat of Stayin Alive by the Bee Gees), push to a depth of at least 2 inches (5 cm), allow full chest recoil after each compression (do not lean on the chest), and minimize interruptions in compressions. Continue until an AED arrives, EMS takes over, or the person starts moving.

Adult CPR — Conventional CPR

For trained rescuers: 30 chest compressions followed by 2 rescue breaths (30:2 ratio). Open the airway using the head-tilt, chin-lift maneuver. Give rescue breaths: pinch the nose, make a seal over the mouth, give 1-second breaths, watching for chest rise. Each breath should produce visible chest rise. Avoid excessive ventilation, which reduces cardiac output.

Child and Infant CPR

For children (1 year to puberty): use the same 30:2 ratio. Compress at least 2 inches (5 cm) — one hand or two hands as needed. For infants (<1 year): use two fingers for compression (just below the nipple line). Compress at least 1.5 inches (4 cm). 30:2 ratio with two rescuers; 15:2 with two rescuers. Give gentle breaths — do not overinflate infant lungs.

Using an AED

Turn on the AED (automated voice prompts guide you). Expose the chest — remove any medication patches, wipe water or sweat, and shave excessive chest hair if needed. Place pads: one on the upper right chest and one on the lower left side (anterior-lateral position). For children 1–8 years, use pediatric pads if available (placed anterior-posterior). Ensure no one is touching the patient. The AED analyzes the heart rhythm — do not touch the patient during analysis. If a shock is advised, ensure no one is touching the patient, then press the shock button. Resume CPR immediately for 2 minutes, then repeat the analysis.

Recovery Position

If the person is unresponsive but breathing normally (no suspected cardiac arrest), place them in the recovery position on their side to maintain an open airway and allow fluids to drain. Roll the person onto their side, tilt the head back to keep the airway open, and place the top hand under the cheek. Monitor breathing continuously.

When to Stop CPR

Stop only when: the person starts moving or breathing normally, an AED is ready to analyze, trained EMS personnel arrive and take over, or you are too exhausted to continue.

★ Key Concept

Each year, over 350,000 out-of-hospital cardiac arrests occur in the US. Bystander CPR is performed in only 40% of cases. When bystander CPR is performed, survival rates double or triple. Hands-only CPR (compressions without breaths) is easy to learn, effective, and recommended for untrained bystanders. The single most important factor for survival is immediate high-quality CPR and early defibrillation. CPR training programs (AHA HeartCode, Red Cross) and community education initiatives (CPR in Schools) increase bystander CPR rates. Every second counts.

Summary

CPR saves lives. Recognize cardiac arrest by unresponsiveness and abnormal breathing. Activate emergency response immediately. Push hard and fast in the center of the chest at 100–120 compressions per minute. Use an AED as soon as available. For adults, hands-only CPR is effective for untrained rescuers. For children and infants, conventional CPR with breaths is recommended. Training and regular practice improve CPR quality and confidence.