CPR

CPR stands for cardiopulmonary resuscitation. It’s an emergency procedure that can save your life if you’re in cardiac arrest. This means your heart stops beating and can’t pump blood out to your body. The key part of CPR is chest compressions (pushing hard and fast in the center of the chest). This keeps some blood flowing to vital organs. CPR may also involve mouth-to-mouth breaths, which give you oxygen.

Healthcare providers, like doctors, nurses and paramedics, routinely perform CPR both in and out of hospitals. Others, called lay rescuers, can also perform CPR wherever it’s needed, like at homes, gyms and shopping malls.

If you’re reading this and aren’t a healthcare provider, you have the opportunity to be a lay rescuer. This means you can save someone’s life, no matter who you are. Lay rescuers include people with CPR certification (you take classes and get an official certificate), as well as those without it. You’ll do the type of CPR that reflects your training and comfort level.

Types of CPR

There are two main types of CPR:

• CPR with breaths (conventional CPR): You use chest compressions and mouth-to-mouth breaths. You need CPR certification to do this type.
• Hands-only CPR: You only use chest compressions (no breaths). You don’t need CPR certification to do this type. You can learn on your own.

Both types are effective and can be lifesaving within the first few minutes of cardiac arrest in adults. However, CPR with breaths is more helpful in situations where CPR must go on for longer than a few minutes. This is because the person’s blood needs more oxygen at that point to prevent damage to vital organs like the brain.

How to recognize when someone needs CPR

A person needs CPR if they’re unconscious and have absent or abnormal breathing. Here’s what that means:

• Unconscious: This is also called being “unresponsive.” It means the person doesn’t respond if you shout, say their name or tap them on the shoulder.
• Absent or abnormal breathing: This means the person either isn’t breathing, or they’re breathing in ways that don’t sound normal. It may sound like they’re gasping for air.

These are signs that the person is in cardiac arrest.

What not to do

When someone’s in cardiac arrest, do NOT delay CPR in order to:

• Check for a pulse: The latest guidelines say that lay rescuers should NOT check for a pulse (this is true even if you’re CPR certified). This can waste valuable time. If the person is unresponsive and not breathing right, start CPR right away.
• Check their airways for an object that’s stuck: The guidelines do NOT recommend routine inspection of the mouth or throat when a person is in cardiac arrest. Also, never do a “blind finger sweep,” looking for an object. This can push any object deeper into the airway.

The only time to check the airways for a lodged object is if you witness someone collapse while choking. In that case, quickly look in their mouth. Don’t feel around for an object. But if you can clearly see an object and it’s easily removed, you can remove it. Otherwise, start CPR right away.

Before starting CPR, quickly ask someone to:

• Call 911 (or your local emergency services number): Ideally, someone nearby can make the call so you can immediately start CPR. But if you’re alone, call for emergency help and put the phone on speaker while you get started.
• Get an automated external defibrillator (AED): An AED is a device that can restart the heart. AEDs are available in many public places. You can use them even if you don’t have training. The device will give you instructions aloud.

It may take some minutes for emergency services to arrive and for someone to find an AED. Don’t wait. Start CPR immediately.

CPR steps for adults and teens

1. Make sure the person is on a firm, flat surface. They should be lying on their back. Gently position the person as needed.
2. Kneel down. You should be next to the person, with your knees about shoulder width apart.
3. Place your hands on their chest. Put the heel of one hand in the middle of their chest, with your fingers lifted upward and spread out. Put your other hand on top and interlace your fingers. Your fingers should be slightly lifted up off their chest, with the lower heel pressing down.
4. Position your body. Your shoulders should be directly over your hands. Your arms should extend straight downward, with your elbows locked (not bent). This helps you use your body weight to push down forcefully enough.
5. Start chest compressions. Push down on the middle of the person’s chest with hard, fast movements. Their chest should go down by at least 2 inches (5 centimeters) each time, but not more than 2.4 inches (6 centimeters). Their chest should rise up before you push again.
6. Keep a steady pace. Do chest compressions at a rate of 100 to 120 per minute. This follows the beat of “Stayin’ Alive,” by the Bee Gees, and “Crazy in Love,” by Beyoncé and Jay-Z. Make sure you allow the person’s chest to come all the way back up between compressions.
7. Give breaths (IF TRAINED). For hands-only CPR, simply continue doing chest compressions. But if you’re CPR certified and willing to give breaths, you should do so. Follow the guidance you learned in your training. You should generally give two breaths after every 30 compressions.

Continue doing CPR until any of the following happen:

• The person starts breathing normally again.
• First responders arrive and take over the care.
• An AED is available to use (if this happens, stop CPR and start using the AED right away).

If at any point, you feel too tired to continue, let someone else who’s ready step in. Make the switch as quickly as possible so there aren’t long breaks in between compressions. Generally, it’s advised to switch personnel every two minutes.

CPR steps for children and babies

There are some key differences when you’re doing CPR for anyone 12 or younger. Here’s what to know:

• CPR with breaths is best for children and babies. This means, ideally, someone who’s CPR certified will step in. But if no one with training is available, it’s OK to do hands-only CPR.
• For infants, don’t use both hands for chest compressions. Instead, use modified techniques that are more appropriate for an infant’s small size. These are described farther below. The infant’s chest should go down by about 1.5 inches (4 centimeters).
• For children, use either one or two hands for chest compressions. It depends on the size of the child. For children 1 to 8 years old, using one hand may be OK as long as you can keep the proper form. The child’s chest should go down by about 2 inches (5 centimeters).

When performing CPR on an infant (1 to 12 months old), use one of the following techniques for chest compressions:

• The “two thumb-encircling hands” technique: You wrap both hands around the infant’s upper body. Your thumbs should meet at the center of their chest, forming an upside-down V. Push down with both thumbs. This is better than doing two-finger compressions (an older method).
• The “heel-of-one-hand” technique: If you can’t wrap both hands around the infant, then use the heel of one hand (not both) to do chest compressions.

What are the potential benefits and risks of CPR?

CPR can save your life if you receive it right after going into cardiac arrest. CPR keeps blood moving through your body. This may prevent organ damage, like cerebral hypoxia.

Some people with certain preexisting health conditions might not experience the same benefits from CPR. It depends on how sick you are before you go into cardiac arrest. Consider speaking with a healthcare provider you trust about what your recovery or outlook might look like if you needed CPR.

Possible risks of CPR include broken ribs and injury to organs in your chest. This is because chest compressions must be forceful to keep blood circulating and keep you alive.

What happens immediately after CPR?

If you’re a lay rescuer, you’ll step back when first responders arrive. They’ll take over and begin providing medical care. They’ll transport the person to a hospital as soon as possible. If the person survives, healthcare providers will check for any organ damage from a lack of oxygen. They’ll also determine the cause of cardiac arrest and provide any needed treatment.

If a cardiac arrest occurs at home and an individual wakes up after CPR from a non-trained family member, they should be evaluated immediately by a healthcare team. This is true even if they look well.