Learning cardiopulmonary resuscitation

Written by Sarah Gehrke, MSN, RN, Sarah has worked in various roles at Coffee Medical Center including nurse, education director, and quality assurance director.

Cardiopulmonary resuscitation (CPR) is a procedure used in emergency situations on a person who has suffered cardiac arrest, has nearly drowned, or in a life-threatening condition possibly due to the progression of complications from an adverse health event.

When to use CPR

Use CPR when the patient has an undetectable heartbeat and is not breathing—include rescue breathing and chest compressions. Rescue breathing supplements oxygen to the lungs and chest compressions circulate oxygenated blood to the vital organs and brain.

Purpose of CPR

The purpose of CPR is to artificially circulate blood to the patient’s brain and heart until medical professionals achieve the restoration of a normal heart and lung function with the aid of a cardiac defibrillator, medications, and other advanced medical interventions.

History and progression of CPR

Modern CPR, combining chest compressions and mouth-to-mouth breathing, was developed in 1960 when the American Heart Association (AHA) began teaching physicians closed-chest cardiac resuscitation.

The general public and healthcare professionals, such as doctors, nurses, and emergency medical technicians, can perform CPR. The American Heart Association recommends providing CPR with a barrier device. If a healthcare professional does not have a barrier device, hands-only CPR is acceptable for an adult victim until a barrier device is available. For those non-professionals who have little training in rescue breathing, providing hands-only CPR can increase the chances of survival.

Chest compressions only

Use hands-only CPR when the rescuer has little training in rescue breathing or for healthcare providers when a barrier device is not available. For adults, rescuers should:

• Make sure the area is safe, then tap the individual on the shoulder and shout "Are you OK?" to ensure that the person needs help.
• Call 911 and begin compressions if an adult is unresponsive and not breathing or only having occasional gasping breaths.
• Ask another witness 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.
• Place their hands in the middle of the patient’s chest with one hand atop the other.
• Perform compressions hard and fast at the rate of 100-120 compressions per minute—depress the chest by at least two inches.
• Allow for complete recoil of the chest with each compression to promote the heart to fill with blood.

Note. Rescuers should continue giving chest compressions for as long as they are physically able or until professional help arrives. Chest compressions must be faster than the normal heartbeat and performed hard enough because there is only a 20 to 30 percent chance of re-establishing blood flow as efficiently as the heart is in circulating the blood.

The focus on chest compressions eliminates the confusion about how to open the airway and do rescue breathing, which saves precious time. The compressions circulate the oxygen-rich blood to the heart and brain, which significantly increases the patient’s chances of survival.

CPR with rescue breathing for children and adults

When used on adult patients, CPR with rescue breathing includes both chest compressions and breaths. The rescuer should:

• Make sure the area is safe, then tap the individual on the shoulder and shout “Are you OK?” to ensure that the person needs help.
• Call 911 immediately and then begin chest compressions.
• Ask another witness 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.
• Place both hands in the middle of the chest, one on top of the other, the rescuer should press down hard and perform 30 compressions.
• Perform compressions hard and fast at the rate of 100-120 compressions per minute—depress the chest by at least two inches for an adult and at least ⅓ of the chest depth for a child (about 2 inches).
• Tilt the patient’s head back, lift the chin, and pinch the nose closed—with a face shield, cover the patient’s mouth with his or her own and blow hard until the patient’s chest rises. If using a pocket mask, cover the nose and mouth and blow into the mouthpiece until the chest rises.
• Give two breaths, each lasting one second, and then return to chest compressions.
• Alternates 30 compressions and two breaths until professional help arrives.

CPR for children is the same as CPR for adults; however, If a child younger than eight has collapsed: do not leave the child alone until you have done CPR for about 2 minutes. After 2 minutes of care, then call 911.

CPR for infants and children under six months

CPR for infants is slightly different. The rescuer should:

• Check the surrounding area for safety. Shout “Are you OK?” and tap the child’s shoulder to determine if they are unresponsive. For infants, flick the bottom of the foot to elicit a response.
• Do not leave the infant alone until you have done CPR for about 2 minutes. After 2 minutes of care, then call 911.
• Ask another witness 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.
• Place two or three fingers of one hand (usually the middle and index finger) just below the nipples at the center of the chest and give 30 gentle chest compressions which should compress the chest at least 1.5 inches.
• Perform compressions hard and fast at the rate of 100-120 compressions per minute.
• After 30 compressions, using a face shield, lift the child’s chin and cover the child’s nose and mouth with his or her own, making a complete seal. If using a pocket mask, cover the nose and mouth and blow into the mouthpiece until the chest rises.
• Deliver two rescue breaths, each lasting one second, which causes the chest to rise before resuming chest compressions.

CPR facts

Currently, only 30% of people who collapse because of cardiac arrest outside of a hospital receive CPR from bystanders.

CPR is most effective when done 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, an individual who receives CPR has a survival rate of 30% if an AED arrives several minutes early to restart their heart rhythm. Rates of survival until discharge from the hospital range from as low as 2% in some areas to as high as 20%.

Among these survivors, over 60% usually regain their previous mental capacity. Performing CPR and immediately calling 911 gives a person the greatest 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.

• 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.

• History of CPR: Modern cardiopulmonary resuscitation—not so new after all.

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