How to Do CPR

When to Start CPR

Knowing when to start CPR matters more than perfecting your technique. A person in cardiac arrest has minutes before brain damage begins. Your decision to act is the most important factor in their survival.

According to the American Heart Association, you should begin CPR immediately if someone meets all three of these criteria:

1. 1They are unresponsive. Tap their shoulders firmly and shout, "Are you okay?" If they don't respond, move to the next check.
2. 2They are not breathing normally. Look at their chest for 5 to 10 seconds. Occasional gasps (called agonal breathing) are not normal breathing. If you see gasping or no chest movement at all, treat it as cardiac arrest.
3. 3They have no pulse (optional check). The AHA advises untrained bystanders to skip the pulse check entirely and start compressions. Even trained responders should spend no more than 10 seconds checking for a pulse at the side of the neck.

Before starting compressions, call 911 (or ask someone nearby to call) and request an AED if one is available. Place your phone on speaker so the dispatcher can guide you while you work.

Hands-Only CPR: Step by Step

Hands-only CPR is the method the American Heart Association recommends for untrained bystanders and anyone who is not comfortable giving rescue breaths. It is simple, effective, and requires no equipment. Studies published in the Journal of the American Medical Association show that hands-only CPR is just as effective as traditional CPR for adults who collapse outside of a hospital.

1. 1Call 911. Do this first or have someone else call while you begin.
2. 2Place the person on a firm, flat surface. Roll them onto their back if needed.
3. 3Kneel beside their chest. Position yourself so your shoulders are directly above their sternum.
4. 4Place the heel of one hand on the center of the chest. This is on the lower half of the breastbone, between the nipples.
5. 5Place your other hand on top and interlace your fingers. Keep your fingers lifted off the ribs. Press with the heel of your palm only.
6. 6Lock your elbows and push straight down. Use your body weight, not just your arm strength. Compress the chest at least 2 inches deep for adults.
7. 7Push hard and fast at 100 to 120 compressions per minute. The beat of "Stayin' Alive" by the Bee Gees matches this tempo perfectly. You can hum it in your head to keep pace.
8. 8Allow the chest to fully recoil between compressions. Do not lean on the chest. Full recoil lets the heart refill with blood.
9. 9Do not stop. Continue compressions until emergency responders arrive, an AED becomes available, or the person starts breathing normally.

CPR is physically exhausting. If someone else is available, switch every 2 minutes to maintain compression quality. Minimize any pauses during the switch to fewer than 10 seconds.

CPR with Rescue Breaths

Traditional CPR combines chest compressions with rescue breaths in a 30:2 ratio. The American Red Cross and AHA recommend this method for trained responders, especially for drowning victims, children, and infants where the cause of cardiac arrest is more likely respiratory.

1. 1Perform 30 chest compressions using the same technique described above: hard, fast, center of chest, at least 2 inches deep.
2. 2Open the airway. Tilt the head back by placing one hand on the forehead and lifting the chin with two fingers of your other hand. This is called the head-tilt, chin-lift maneuver.
3. 3Give 2 rescue breaths. Pinch the nose shut, create a seal over the mouth, and blow for about 1 second per breath. Watch for the chest to rise visibly.
4. 4If the chest does not rise, reposition the head and try again. Do not attempt more than 2 breaths before returning to compressions.
5. 5Repeat the cycle. 30 compressions, then 2 breaths. Continue without stopping.

If a pocket mask or barrier device is available, use it to reduce direct mouth-to-mouth contact. However, the absence of a barrier device should never stop you from acting.

CPR for Children and Infants

CPR for children (ages 1 to puberty) and infants (under 1 year) follows the same basic principles, with key adjustments for their smaller bodies. Cardiac arrest in children is more often caused by breathing problems, so rescue breaths are especially important.

For children ages 1 to puberty:

• Use one or two hands for compressions depending on the child's size.
• Compress the chest about 2 inches deep (roughly one-third the depth of the chest).
• Use the same 30:2 compression-to-breath ratio.
• Push at the same rate: 100 to 120 compressions per minute.

For infants under 1 year:

• Use two fingers (index and middle finger) placed just below the nipple line on the breastbone.
• Compress about 1.5 inches deep (one-third the depth of the infant's chest).
• Cover the infant's mouth and nose with your mouth when giving rescue breaths.
• Give gentler breaths, just enough to make the chest rise visibly. A puff of air from your cheeks is often sufficient.
• Use the 30:2 ratio for a single rescuer, or 15:2 if two trained rescuers are present.

For both children and infants, give 5 cycles of 30:2 (about 2 minutes) before calling 911 if you are alone and no one else is available to call. This differs from adult CPR because the cause is more likely a breathing emergency, and those initial breaths can be lifesaving.

Common Mistakes During CPR

Even imperfect CPR is dramatically better than no CPR. That said, knowing the most common errors helps you deliver the most effective compressions possible.

• Not pushing hard enough. This is the most common mistake. Two inches is deeper than most people expect. You may feel ribs crack, especially in older adults. This is normal and not a reason to stop. Broken ribs heal. Cardiac arrest without CPR does not.
• Pushing too slowly. 100 to 120 compressions per minute is faster than people realize. Use a tempo song to stay on pace.
• Not allowing full chest recoil. Leaning on the chest between compressions prevents the heart from refilling with blood. Lift your weight completely between each push.
• Stopping compressions too often. Every pause in compressions drops blood flow to the brain. Minimize interruptions, even during rescuer switches or AED analysis.
• Fear of causing harm. Many bystanders hesitate because they worry about hurting the person. Remember: someone in cardiac arrest is clinically dead. You cannot make it worse. You can only help.
• Spending too long checking for a pulse. If you are unsure, skip the pulse check and start compressions. The AHA recommends untrained bystanders skip it entirely.

What Happens After CPR

If the person starts breathing normally again, your next steps matter. Here is what to do once CPR has been effective or emergency responders arrive.

If the person starts breathing on their own:

1. 1Place them in the recovery position. Roll them onto their side with their top knee bent forward for stability. Tilt their head back slightly to keep the airway open.
2. 2Monitor their breathing continuously. Be ready to restart CPR immediately if they stop breathing again.
3. 3Stay with them until emergency responders take over. Even if they seem alert, they need advanced medical care.

When to stop CPR:

• Emergency medical services arrive and take over.
• An AED becomes available and is ready to analyze the heart rhythm.
• The person starts breathing normally and shows signs of life.
• You become physically unable to continue and no one else can take over.
• The scene becomes unsafe (fire, structural collapse, or other hazards).

After the event, it is completely normal to feel shaken, exhausted, or emotional. Whether the outcome was positive or not, what you did took courage. Talk to someone you trust, and do not hesitate to seek professional support if the experience stays with you.