Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in many emergencies,

including 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.

It's far better to do something than to do nothing at all if you're fearful that your knowledge or
abilities aren't 100 percent complete. Remember, the difference between your doing something
and doing nothing could be someone's life.

Here's advice from the American Heart Association:

Untrained. If you're not trained in CPR, then provide hands-only CPR. That means
uninterrupted chest compressions of about 100 a minute until paramedics arrive
(described in more detail below). You don't need to try rescue breathing.
Trained and ready to go. If you're well-trained and confident in your ability, begin with
chest compressions instead of first checking the airway and doing rescue breathing. Start
CPR with 30 chest compressions before checking the airway and giving rescue breaths.
Trained but rusty. If you've previously received CPR training but you're not confident in
your abilities, then just do chest compressions at a rate of about 100 a minute. (Details
described below.)

The above advice applies to adults, children and infants needing CPR, but not newborns.

CPR can keep oxygenated blood flowing to the brain and other vital organs until more definitive
medical treatment can restore a normal heart rhythm.

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.

To learn CPR properly, take an accredited first-aid training course, including CPR and how to
use an automated external defibrillator (AED). If you are untrained and have immediate access to
a phone, call 911 before beginning CPR. The dispatcher can instruct you in the proper
procedures until help arrives.

Before you begin

Before starting CPR, check:

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, one should call 911 or the
local emergency number and one should begin CPR. If you are alone and have immediate
access to a telephone, call 911 before beginning CPR unless you think the person has
 become unresponsive because of suffocation (such as from drowning). In this special
case, begin CPR for one minute and then call 911 or the local emergency number.
If an AED is immediately available, deliver one shock if instructed by the device, then
begin CPR.

Remember to spell C-A-B

The American Heart Association uses the acronym of CAB compressions, airway, breathing
to help people remember the order to perform the steps of CPR.

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). Push hard at a rate
of about 100 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 checking the airway and rescue breathing.

Airway: Clear the airway

1. 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.
2. Check for normal breathing, taking no more than five or 10 seconds. Look for chest
motion, listen for normal breath sounds, and feel for the person's breath on your cheek
and ear. Gasping is not considered to be normal breathing. If the person isn't breathing
normally and you are trained in CPR, begin mouth-to-mouth breathing. If you believe the
person is unconscious from a heart attack and you haven't been trained in emergency
procedures, skip mouth-to-mouth breathing and continue chest compressions.

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.
3. Resume chest compressions to restore circulation.
4. If the person has not begun moving after five cycles (about two minutes) and 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, a
911 or other 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.

To perform CPR on a child

The procedure for giving CPR to a child age 1 through 8 is essentially the same as that for an
adult. The differences are as follows:

If you're alone, perform five cycles of compressions and breaths on the child this
should take about two minutes before calling 911 or your local emergency number or
using an AED.
Use only one hand to perform chest compressions.
Breathe more gently.
Use the same compression-breath rate as is used for adults: 30 compressions followed by
two breaths. This is one cycle. Following the two breaths, immediately begin the next
cycle of compressions and breaths.
After five cycles (about two minutes) of CPR, if there is no response and an AED is
available, apply it and follow the prompts. Use pediatric pads if available, for children
ages 1 through 8. If pediatric pads aren't available, use adult pads. Do not use an AED for
children younger than age 1. 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, a 911 or other emergency medical operator may be able
to guide you in its use.

Continue until the child moves or help arrives.

To perform CPR on a baby

Most cardiac arrests in babies occur from lack of oxygen, such as from drowning or choking. If
you know the baby has an airway obstruction, perform first aid for choking. If you don't know
why the baby isn't breathing, perform CPR.

To begin, examine the situation. Stroke the baby and watch for a response, such as movement,
but don't shake the baby.

If there's no response, follow the CAB procedures below and time the call for help as follows:

If you're the only rescuer and CPR is needed, do CPR for two minutes about five
cycles before calling 911 or your local emergency number.
If another person is available, have that person call for help immediately while you attend
to the baby.

Compressions: Restore blood circulation

1. Place the baby on his or her back on a firm, flat surface, such as a table. The floor or
ground also will do.
2. Imagine a horizontal line drawn between the baby's nipples. Place two fingers of one
hand just below this line, in the center of the chest.
3. Gently compress the chest about 1.5 inches (about 4 centimeters).
4. Count aloud as you pump in a fairly rapid rhythm. You should pump at a rate of 100
compressions a minute.

Airway: Clear the airway

1. After 30 compressions, gently tip the head back by lifting the chin with one hand and
pushing down on the forehead with the other hand.
2. In no more than 10 seconds, put your ear near the baby's mouth and check for breathing:
Look for chest motion, listen for breath sounds, and feel for breath on your cheek and ear.

Breathing: Breathe for the baby

1. Cover the baby's mouth and nose with your mouth.

2. Prepare to give two rescue breaths. Use the strength of your cheeks to deliver gentle puffs
of air (instead of deep breaths from your lungs) to slowly breathe into the baby's mouth
one time, taking one second for the breath. Watch to see if the baby's chest rises. If it
does, give a second rescue breath. If the chest does not rise, repeat the head-tilt, chin-lift
maneuver and then give the second breath.
3. If the baby's chest still doesn't rise, examine the mouth to make sure no foreign material
is inside. If an object is seen, sweep it out with your finger. If the airway seems blocked,
perform first aid for a choking baby.
4. Give two breaths after every 30 chest compressions.
 5. Perform CPR for about two minutes before calling for help unless someone else can
make the call while you attend to the baby.
6. Continue CPR until you see signs of life or until medical personnel arrive.

1. CALL
Check the victim for unresponsiveness. If the person is not
responsive and not breathing or not breathing normally. Call
911 and return to the victim. In most locations the
emergency dispatcher can assist you with CPR instructions.

2. PUMP

If the victim is still not breathing normally, coughing or

moving, begin chest compressions. Push down in the center
of the chest 2 inches 30 times. Pump hard and fast at the
rate of at least 100/minute, faster than once per second.

3. BLOW
Tilt the head back and lift the chin. Pinch nose and cover the
mouth with yours and blow until you see the chest rise.
Give 2 breaths. Each breath should take 1 second.

CONTINUE WITH 30 PUMPS AND 2 BREATHS UNTIL HELP ARRIVES

NOTE: This ratio is the same for one-person & two-person CPR. In two-person
CPR the person pumping the chest stops while the other gives mouth-to-mouth
breathing.

What complications can occur?

What about checking for a pulse?

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How to Perform CPR

Learning how to perform cardio-pulmonary resuscitation (CPR)

saves lives. While no statistics are available on the exact number
of lives sudden cardiac arrest claims per year, approximately
335,000 people die annually of coronary heart disease without
being hospitalized or about 918 Americans each day, according
to the American Heart Association (AHA).

Conventional CPR consists of chest compressions and rescue

breathing. The American Heart Association continues to support
this approach to CPR, but recent research demonstrates that rescue
breathing may be unnecessary and potentially detrimental in cases
of cardiac arrest. In the interest of presenting complete
information, however, ACEP is including instructions on how to provide rescue breaths in this
guide for laypersons who choose to employ them.

The tips provided below are based on procedures recommended by the AHA and are not a
substitute for formal training in CPR. The AHA and the American Red Cross offer CPR courses;
to register, contact the AHA at 1-800-AHA-USA1 or your local American Red Cross chapter.
Everyone in your family should take one of these courses, and you should have your CPR skills
tested at least every two years.

Automated External Defibrillators (AEDs) are increasingly available at many locations, such as
shopping malls and airports. They are small, lightweight devices used to assess a persons heart
rhythm. An AED can detect the need for and administer an electric shock to restore a normal
heart rhythm in people with sudden cardiac arrest. ACEP supports widespread distribution of
AEDs, as long as it is coordinated with existing EMS systems and includes proper training.
Logical places for AEDs include police cars, theaters, sports arenas, public buildings, business
offices and airports. An increasing number of commercial airplanes are now equipped with AEDs
and enhanced medical kits.
CPR is typically administered in cases of cardiac arrest. Signs of cardiac arrest include an
absence of heartbeats, blood flow and pulse. When blood stops flowing to the brain, the person
becomes unconscious and stops regular breathing.

The ABCs of CPR are Airway, Breathing, and Circulation. This acronym is used to help you
remember the steps to take when performing CPR.

Airway

If a person has collapsed, determine if the person is unconscious. Gently prod the victim and
shout, Are you okay? If there is no response, shout for help. Call 911 or your local emergency
number.
If the person is not lying flat on his or her back, roll him or her over, moving the entire body at
one time.

Open the persons airway. Lift up the chin gently with one hand while pushing down on the
forehead with the other to tilt the head back. (Do not try to open the airway using a jaw thrust
for injured victims. Be sure to employ this head tilt-chin lift for all victims, even if the person is
injured.)

If the person may have suffered a neck injury, in a diving or automobile accident, for example,
open the airway using the chin-lift without tilting the head back. If the airway remains blocked,
tilt the head slowly and gently until the airway is open.

Once the airway is open, check to see if the person is breathing.

Take five to 10 seconds (no more than 10 seconds) to verify normal breathing in an unconscious
adult, or for the existence or absence of breathing in an infant or child who is not responding.

If opening the airway does not cause the person to begin to breathe, it is advised that you begin
providing rescue breathing (or, minimally, begin providing chest compressions).

Breathing (Rescue Breathing)

Pinch the persons nose shut using your thumb and forefinger. Keep the heel of your hand on the
persons forehead to maintain the head tilt. Your other hand should remain under the persons
chin, lifting up.

Inhale normally (not deeply) before giving a rescue breath to a victim.

Immediately give two full breaths while maintaining an air-tight seal with your mouth on the
persons mouth. Each breath should be one second in duration and should make the victims
chest rise. (If the chest does not rise after the first breath is delivered, perform the head tilt-chin
lift a second time before administering the second breath.) Avoid giving too many breaths or
breaths that are too large or forceful.

Circulation (Chest Compressions)

After giving two full breaths, immediately begin chest compressions (and cycles of compressions
and rescue breaths). Do not take the time to locate the persons pulse to check for signs of blood
circulation.

Kneel at the persons side, near his or her chest.

With the middle and forefingers of the hand nearest the legs, locate the notch where the bottom
rims of the rib cage meet in the middle of the chest.

Place the heel of the hand on the breastbone (sternum) next to the notch, which is located in
the center of the chest, between the nipples. Place your other hand on top of the one that is in
position. Be sure to keep your fingers up off the chest wall. You may find it easier to do this if you
interlock your fingers.

Bring your shoulders directly over the persons sternum. Press downward, keeping your arms
straight. Push hard and fast. For an adult, depress the sternum about a third to a half the depth
of the chest. Then, relax pressure on the sternum completely. Do not remove your hands from
the persons sternum, but do allow the chest to return to its normal position between
compressions. Relaxation and compression should be of equal duration. Avoid interruptions in
chest compressions (to prevent stoppage of blood flow).

Use 30 chest compressions to every two breaths (or about five cycles of 30:2 compressions and
ventilations every two minutes) for all victims (excluding newborns). You must compress at the
rate of about 100 times per minute.

Continue CPR until advanced life support is available.

Using an AED in conjunction with CPR:

If using an AED in the case of a heart attack or cardiac arrest, single shocks should be followed by
immediate CPR for two minutes. Heart rhythm checks should be performed every two minutes
(or after giving about five cycles of CPR); the AED will provide audible prompts at the appropriate
intervals. See AED section for details.
If using an AED on a one- to eight-year-old child, use a child-dose-reduction system if available.
(However, do not use child pads or a child dose on adults in cardiac arrest because the smaller
dose may not defibrillate adults properly.)

CPR for Infants (Up to One Year Old)

Airway

With infants, be careful not to tilt the head back too far. An infants neck is so pliable that
forceful backward tilting might block breathing passages instead of opening them.

Breathing

Do not pinch the nose of an infant who is not breathing. Cover both the mouth and the nose with
your mouth and breathe slowly (one to one and a half seconds per breath), using enough volume
and pressure to make the chest rise.
With a small child, pinch the nose closed, cover the mouth with your mouth and breathe at the
same rate as for an infant. Rescue breathing should be done in conjunction with chest
compressions. (See next section.)

Chest Compressions on Infants

If alone with an unresponsive infant, give five cycles of CPR (compressions and ventilations) for
about two minutes before calling 911 or your local emergency number.
Use only the tips of the middle and ring fingers of one hand to compress the chest at the
sternum (breastbone), just below the nipple line, as described in the table below. The other
hand may be slipped under the back to provide a firm support. (However, if you can encircle
your hands around the chest of the infant, using the thumbs to compress the chest, this is better
than using the two-finger method.)

Depress the sternum between a third to a half the depth of the chest at a rate of at least 100
times a minute.

Two breaths should be given during a pause after every 30 chest compressions on all infants
(excluding newborns).

Continue CPR until emergency medical help arrives.

Small Children (ages one to eight)

Give five cycles of CPR (compressions and ventilations) for about two minutes before calling 911.
Use the heel of one or two hands, as needed, and compress on the breastbone at about the
nipple line.

Depress the sternum about a third to a half the depth of the chest, depending on the size of the
child. The rate should be 100 times per minute.

Give two breaths for every 30 chest compressions (30:2 ratio).

Continue CPR until emergency medical help arrives