CPR

CPR (Cardiopulmonary resuscitation) is ONLY used when a casualty* has stopped breathing or has agonal (irregular) breathing — meaning their chest rises and falls from time to time.

The DR ABC sequence must be performed before carrying out CPR, to ensure that the casualty is not breathing and is unresponsive*.

Before carrying out CPR, call emergency services and put them on speakerphone. This means you can communicate with them while carrying out CPR, and they can guide you if needed.

Performing CPR on adults

To perform CPR on adults, you should carry out cycles of 30 chest compressions followed by 2 rescue breaths. This should be at a rate of roughly ~100–120bpm — a good way to measure this is by carrying out the compressions to the beat of “Stayin’ Alive” or “Baby Shark”.

Chest compressions should aim to push 5cm/2 inches into the chest, which requires a lot of force. You might often hear a creaking/cracking sound under your hands while performing CPR — this is likely to be the cartilage* in the sternum*/ribs breaking, rather than the ribs themselves.

However, it is not uncommon for ribs to break during CPR, and while this can be uncomfortable for the rescuer you should not stop CPR because of it. While skeletal injuries can be extremely painful, and add to the recovery time, an injury is much preferable to death which would certainly occur if compressions are stopped. In addition, most countries have Good Samaritan laws that protect rescuers from being prosecuted* as a result of performing first aid. You are extremely unlikely to find yourself facing legal consequences if the patient doesn’t like the way you delivered CPR, as long as you were clearly acting to the best of your ability and trying to save their life.

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Stretch!

High-quality CPR doubles or triples survival chances, but average bystander CPR quality is often too shallow or too slow. This is why depth (5cm) and correct speed (100–120 bpm) are absolutely critical.

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Performing CPR on children

Performing CPR on children has slightly different requirements to performing it on adults due to the size and oxygen requirement differences. You should start with 5 rescue breaths, before beginning cycles of 30 compressions and 2 rescue breaths. To view this more visually, this is what it should look like:

5–30–2–30–2–30–2 etc, until an ambulance arrives.

The depth of compressions should be the same — roughly 5cm, which should be one-third of the chest diameter.

Performing CPR on babies

When performing CPR on babies, you should not perform compressions with your whole hand. Instead, you should do it with the tips of two fingers. Compression depth should be 4cm, because of the baby’s smaller size. However, the depth of compressions is the most important part. So, if you cannot achieve a depth of 4cm with just the tips of your fingers, you should use the heel of your palm instead.

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Stretch!

Hands-only CPR is fine to treat adults if you're untrained or unwilling to give rescue breaths. However, it's usually not enough for babies or children since they're more likely to go into cardiac arrest because of breathing issues rather than heart problems.

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Summary:

CPR is used when someone is unresponsive and not breathing normally. For adults, give 30 chest compressions followed by 2 rescue breaths at a rhythm of 100–120 bpm. For children, start with 5 rescue breaths, then 30 compressions and 2 breaths. For babies, use two fingers with compressions about 4cm deep. Always call emergency services before starting CPR and follow DR ABC first.

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Glossary:

Casualty: the person that's hurt in a first aid scenario.

Unresponsive: a casualty is unresponsive if they don't respond to voice or pain (as part of the response stage of DR ABC).

Cartilage: a kind of strong, flexible tissue in the body. The top part of your ear is made of cartilage.

Sternum: the long flat bone that is in the middle of your chest. All your ribs connect to it.

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For Older Learners:

Use these questions to challenge yourself!

1. Do you think it should be mandatory for every country to have Good Samaritan laws? Why or why not?

2. People will often hesitate to give CPR to women out of fear of touching their chest, which is of course necessary to give CPR. How could we raise awareness to destigmatise this?

3. Why is hands-only CPR less effective in children compared to adults?

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Further Information:

Simulation: Street Scare

Quiz: Cardiac Arrest Quiz

Further reading:

• Sudden Cardiac Arrest Symptoms & First Aid | St John Ambulance

• First aid - CPR - NHS

• Cardiac Arrests - How to perform CPR and using an AED