CPR is comprised of chest compressions, airway management, and rescue breathing. To deliver high-quality CPR, you must begin high-quality chest compressions quickly, as these are considered the most important factor in giving the person a chance to recover. Compressing the chest circulates blood to the brain and the heart. High-quality chest compressions are delivered at a rate between 100 to 120 beats per minute and at a depth between 2 to 2.4 inches (5 to 6 cm).

The importance of early initiation of CPR by lay rescuers has been re-emphasized by the 2020 ILCOR Guidelines for CPR. The risk of harm to the patient is low if the patient is not in cardiac arrest. Bystanders should not be afraid to start CPR even if they are not sure whether the victim is breathing or is in cardiac arrest.

When the person is unresponsive and is not breathing or only gasping for air, provide CPR.

For adult CPR, do the following:

  1. Make sure the scene and area around the person are safe.
  2. Tap the person and talk loudly: “Are you okay?”
  3. Yell for help. Use a cellphone to call 911/EMS and send a bystander to get an AED.
  4. Check the person’s breathing.
  5. If the person is not responding, breathing, or only gasping, start CPR.
  6. Give 30 compressions at a rate of 100 to 120 beats per minute and at a depth between 2 to 2.4 inches (5 to 6 cm). Let the chest rise back up before you start your next compression.
  7. Open the airway and give two breaths.

Continue giving compressions and breaths until the AED arrives, until advanced help arrives and assumes care, the scene becomes unsafe, or until the person begins to respond.

For lay rescuers trained in chest compression-only CPR, it is recommended that they provide chest compression-only CPR for adults needing resuscitation. For lay rescuers trained in CPR using chest compressions and ventilation, rescue breaths, it is reasonable to provide ventilation, rescue breaths, and chest compressions for the adult in cardiac arrest.

As a rescuer, if you are untrained in CPR, then give the “hands-only” CPR. The “hands-only” CPR is when you give continuous compressions but no breaths.

COMPRESSIONS

Chest compressions have the greatest impact for survival. Many rescuers fail to push hard or fast enough. High-quality chest compressions have the greatest chance to save a life.

Chest compressions should always be given at a rate of 100 to 120 beats per minute and at a depth between 2 to 2.4 inches (5 to 6 cm) for adults in cardiac arrest. Compressing the chest slower than 100 beats per minute is less likely to provide enough circulation to the brain, heart, and other vital organs, while compressing faster than 120 beats per minute does not provide enough time for the heart to fill between each compression, which will reduce output as well. Similarly, pressing the chest deeper than 2.4 inches (6 cm) increases the risk of injuring the person, while not pressing deep enough will not squeeze the heart enough to provide adequate blood flow.

CPR always begins with compressions before administering breaths. Rescuers who are uncomfortable performing mouth-to-mouth and do not have a mask may perform hands-only CPR and give compressions at a rate of 100 to 120 beats per minute and at a depth between 2 to 2.4 inches (5 to 6 cm).

For chest compressions, do the following:

  1. Position the person on their back on a firm, flat surface.
  2. If needed, remove or open up clothing at the neck and chest area.
  3. Feel for the end of the breastbone (sternum). (Figure 14a)
  4. Place the heel of one hand on the lower half of the breastbone. Avoid pressing down on the very end of the breastbone as the bony tip, called the xiphoid process, may break off and slash the liver, resulting in internal bleeding. Put the other hand on top of the first. (Figure 14b)
  5. Press straight down at a rate of 100 to 120 beats per minute and at a depth between 2 to 2.4 inches (5 to 6 cm). (Figure 14c)
  6. Let the chest recoil completely between compressions. Your hands should remain in contact with the person, without bouncing or leaning on the person.

Performing proper CPR is often tiring. Ask to switch positions when tired if another rescuer is available to help. Monitor each other’s performance, providing encouragement, and offering to switch when fatigue sets in.

AED FOR ADULTS

When the heart does not work properly, a person may collapse.

An AED can deliver a shock to help the heart restart its normal rhythm. These portable units have a computer that analyzes the heart rhythm and determines if a shock is needed. Starting CPR immediately and quickly using an AED improves the chances of survival.

The AED is very simple to use. Follow the diagram or voice instructions given by the AED.

Apply the pads properly and let the computer determine if and when a shock is needed. Make sure no one is touching the person if the AED advises you to push the shock button.

If an AED is not quickly available, begin CPR, and send someone to locate an AED.

An AED should be used anytime a person collapses, fails to respond, and is only gasping, or barely breathing.

Turn on the AED and then follow the prompts you see and hear.

 

TO USE AN AED, DO THE FOLLOWING

  1. Turn the power on.
  2. Expose the chest (Figure 17a).
  3. Apply pads on the victim (Figure 17b).
  4. Connect the pads.
  5. Clear the person to make sure no one is touching any part of the victim (Figure 17c).
  6. Let the AED analyze the rhythm.
  7. Follow the prompts such as (Figure 17d): Shock Advised, No Shock Advised, Check Connection, etc.
  8. Resume CPR with compressions.
 

If a person has a medication patch on their chest, remove it before applying the AED pads. Also, if there is a bulge under the skin of their chest, a pacemaker may be present. Avoid placing the AED pads over this device and adjust placement accordingly. If the AED malfunctions or does not work, continue performing CPR until additional help arrives.

ACTIVATING EMS (CALLING 911)

When encountering a person who is unresponsive, barely breathing, or not breathing quickly, call 911/EMS. Immediate activation of EMS by dialing 911 or the appropriate emergency number is the first step in the Chain of Survival. When available, use of a cellular phone may allow activation of EMS without leaving the person. Many cellular phones incorporate a speakerphone function, which allows a lone rescuer to communicate with the 911/EMS operator while delivering care to the person.

In situations where a cell phone is not available, it is preferred to send a second rescuer or a bystander to call 911/EMS, so the injured/ill person is not left alone. That second rescuer or bystander may also retrieve an AED and/or a first aid kit.

Always make sure the scene is safe when approaching an injured/ill person. If you become injured or disabled, you will be unable to help the person and will become a second person to be taken care of by rescuers.

Tap the person and talk loudly: “Are you okay?” If they fail to respond or react, they are considered unresponsive. Yell for help and send somebody to call 911/EMS and get an AED if possible.

Stay on the phone until the 911/EMS operator tells you it is okay to hang up. The operator can help you make decisions and will not delay the arrival of additional help.

After determining that the person is unresponsive, check their breathing. If they are barely breathing or only gasping, begin CPR. Gasping may be forceful or weak, but it is generally ineffective. This is an abnormal sign and often occurs in cardiac arrest. In this situation, immediately begin CPR.

If the person is breathing normally but not responding, roll them onto their side. This can help keep their airway open and prevent them from choking on vomit. You need to monitor their breathing and be prepared to start CPR if their condition worsens.

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