Cardiopulmonary resuscitation (CPR)

Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in many emergencies, including a heart attack or near drowning, in which someone’s breathing or heartbeat has stopped. The American Heart Association recommends that everyone — untrained bystanders and medical personnel alike — begin CPR with chest compressions. 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. CPR can keep oxygenated blood flowing to the brain and other vital organs until more definitive medical treatment can restore a normal heart rhythm.

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 999 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 999 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

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.

Step One – Compressions: Restore blood circulation

  1. Put the person on his or her back on a firm surface.
  2. Kneel next to the person’s neck and shoulders.
  3. 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.
  4. 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.
  5. 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.

Step Two – 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.

Step Three – 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.

  1. 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.
  2. 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.
  3. Resume chest compressions to restore circulation.
  4. 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, an emergency medical operator may be able to guide you in its use. If an AED isn’t available, go to step 5 below.
  5. Continue CPR until there are signs of movement or emergency medical personnel take over.