ACLS Online Library: Learning CPR

Cardiopulmonary resuscitation, or CPR, is a procedure used in emergency circumstances to a person who has suffered cardiac arrest or who has nearly drowned. CPR is used when the patient has no heartbeat and is not breathing and includes rescue breathing and chest compressions. Rescue breathing provides oxygen to the lungs and chest compressions circulate oxygenated blood to the vital organs and brain. The purpose of CPR is to artificially circulate blood to the patient’s brain and heart until normal heart and lung function can be restored by medical professionals with a defibrillator or medications. Modern CPR, combining chest compressions and mouth-to-mouth breaths, was developed in 1960, when the American Heart Association began teaching physicians closed-chest cardiac resuscitation.

CPR may be performed by healthcare professionals, such as doctors, nurses, and emergency medical technicians, and by the general public. The American Heart Association recommends that trained professionals use CPR with rescue breathing and chest compressions and that non-professionals use continuous chest compressions (or “hands-only” CPR without rescue breathing) on adult patients. For children and infants, the AHA continues to recommend CPR with rescue breathing for both professionals and non-professionals.

In “hands-only” CPR, only chest compressions are used. Rescuers should place their hands in the middle of the patient’s chest, with one hand atop the other. Rescuers should perform compressions hard and fast: at least 100 compressions per minute that depress the chest by at least two inches. Rescuers should be sure to bring their hands all the way back up at the end of each compression, which allows the heart to fill with blood. Chest compressions must be faster than the normal heartbeat and performed very hard because they are only 20 to 30 percent as efficient as the heart in circulating the blood.

By focusing on chest compressions only, confusion about how to open the airway and give rescue breathing is eliminated, which saves precious time. The compressions circulate the blood and the oxygen in the blood to the heart and brain, which extends the patient’s chances of survival. The AHA recommends that bystanders call 911 and begin compressions if an adult is unresponsive and not breathing, or having only occasional gasping breaths. Ask another bystander to locate and retrieve an automated external defibrillator (AED), if one is available. Follow the directions on the AED and use it as soon as it arrives. Rescuers should continue giving chest compressions for as long as they are physically able or until professional help arrives.

When used on adult patients, CPR with rescue breathing includes both chest compressions and breaths. The rescuer should call 911 immediately and then begin chest compressions. Placing both hands on the middle of the chest, one on top of the other, the rescuer should press down hard and perform 30 compressions. The rescuer then tilts the patient’s head back, lifting the chin, and pinching the nose closed. Covering the patient’s mouth with his own, the rescuer blows hard until he sees the patient’s chest rise. The rescuer should give two breaths, each lasting one second, and then return to chest compressions. The rescuer then alternates 30 compressions and two breaths until professional help arrives.

CPR for children is the same as CPR for adults. If a child younger than eight has collapsed, call 911 and begin chest compressions immediately. Depress the sternum by two inches on each compression. Perform 30 compressions and then give two rescue breaths, each lasting one second, before returning to chest compressions. If the rescuer is unable to perform rescue breaths or does not know how, he should perform hands-only CPR. 

CPR for infants, or children under one year of age, is slightly different. The rescuer should shout and tap the child’s shoulder to determine that they are unresponsive. The rescuer should then place two or three fingers of one hand just below the nipples at the center of the chest and give 30 gentle chest compressions, which should compress the chest 1.5 inches. After 30 compressions, the rescuer should lift the child’s chin and cover the child’s nose and mouth with his own. The rescuer gives two gentle breaths, each lasting one second, which cause the chest to rise before resuming chest compressions.

Currently, only 30 percent of people who collapse because of cardiac arrest outside of a hospital receive CPR from bystanders. CPR is most effective when begun within four minutes after a person collapses and loses their heartbeat and breathing, but overall survival rates for people who collapse outside a hospital are low. Overall, a person who receives CPR has a survival rate of 30 percent if an AED arrives in several minutes to restart their heart. Rates of surviving until discharge from the hospital range from as low as two percent in some areas to as high as 20 percent. Of these, over 60 percent regain their previous mental capacity. Performing CPR and calling 911 immediately gives a person the highest possible chance of survival after collapsing, doubling or tripling their chances of survival.

Additional Resources:

• CPR First Aid: What CPR is, how it works, and who should perform the different types of CPR.

• Hands-Only CPR: An explanation of CPR using only chest compressions; includes free smart phone apps.

• Introduction to CPR: Facts and statistics about CPR.

• Steps of CPR: Table breaks down and explains the steps of CPR and gives the appropriate actions to take with adults, infants, and children needing CPR.

• Learning Resources: CPR information, video demonstrations, and smart phone applications.

• Chest Compressions: Video and information on Continuous Chest Compressions.

• CPR Review: Steps and diagrams for performing CPR on infants, children under 8, and older children and adults.

• The ABCs of CPR: Steps of CPR for adults, children, and infants for rescue breathing and chest compression CPR.

• CPR Facts: Why CPR is important, what happens during CPR, and the risks of CPR.

• The Exam: Tips for passing a Red Cross CPR certification exam.

• History of CPR: A brief overview of CPR from the 1950s to the present.

• CPR Resources: An overview of CPR with resources to learn more about its effectiveness and the technique.

• CPR Simpfliciation: Background on why recommendations for CPR have changed for non-medical professionals.

• Heart Disease and CPR: Review of the types of CPR with links to more detailed information; site also includes information on heart diseases.

• Heart Attack and CPR: Detailed information on symptoms of a heart attack and how to perform CPR.