From the Guidelines
Cardiopulmonary resuscitation (CPR) should be performed using the CAB approach: Compressions, Airway, Breathing, with a focus on high-quality chest compressions, as recommended by the 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care 1.
Key Components of CPR
- For adult CPR, place the heel of one hand on the center of the chest (lower half of sternum), place your other hand on top, and compress the chest at least 2 inches (5 cm) deep at a rate of 100-120 compressions per minute, as emphasized in the 2015 guidelines update 1 and further detailed in the 2015 adult advanced cardiovascular life support guidelines 1.
- After 30 compressions, open the airway using the head-tilt chin-lift method and give 2 rescue breaths, each lasting about 1 second, as recommended in the 2010 guidelines 1.
- Continue this 30:2 ratio until emergency services arrive or an AED becomes available.
Special Considerations
- For children (1-puberty), use one or two hands for compressions at 1.5-2 inches depth, and for infants (under 1 year), use two fingers for compressions at 1.5 inches depth, as outlined in the 2010 guidelines 1.
- If you're untrained or uncomfortable with rescue breaths, perform hands-only CPR with continuous chest compressions, as recommended in the 2008 hands-only CPR advisory 1.
Use of Automated External Defibrillators (AEDs)
- When using an AED, turn it on, follow the voice prompts, attach pads to the bare chest, and deliver a shock if advised, as recommended in the 2010 guidelines 1.
Importance of Immediate Action
- CPR works by manually circulating blood to vital organs, particularly the brain, which begins to suffer permanent damage after 4-6 minutes without oxygen, making immediate action crucial for survival, as highlighted in the 2015 guidelines update 1.
From the Research
Guidelines for Cardiopulmonary Resuscitation (CPR)
The guidelines for CPR are as follows:
- Chest compressions should be initiated as soon as cardiac arrest is recognized, with a depth of at least 5 cm and a rate of 100-120 compressions per minute for adults 2, 3, 4, 5.
- Good quality compressions are recommended, with arms extended, elbows locked, shoulders directly over the casualty's chest, and the heel of the palm on the lower half of the sternum 2, 3.
- Two quick mouth-to-mouth ventilations (each 400-600 mL tidal volume) should be delivered after every 30 chest compressions 2, 3, 4.
- Chest compression-only CPR is recommended for lay rescuers, dispatcher-assisted CPR, and those unable or unwilling to give ventilations 2, 3, 4.
- CPR should be stopped when the casualty wakes up, an emergency team takes over casualty care, or if an automated external defibrillator prompts for analysis of heart rhythm or delivery of shock 2, 3.
Key Recommendations
- Minimize interruptions in chest compressions 4, 6, 5.
- Use an automated external defibrillator (AED) as soon as possible 3, 5.
- Provide high-quality chest compressions throughout any advanced life support intervention, paused briefly only to enable specific interventions 6.
- Targeted temperature management is recommended in postresuscitation care, with a constant body temperature between 32-36°C for at least 24 hours 5.
Special Considerations
- For pediatric resuscitation, the compression-to-ventilation ratio depends on the number of rescuers available, and a 30:2 ratio is acceptable even for rescuers with a duty to respond if they are alone 4, 6.
- For newborn resuscitation, the recommended compression:ventilation ratio remains at 3:1 6.
- Therapeutic hypothermia is recommended for comatose survivors of cardiac arrest associated initially with shockable rhythms, as well as non-shockable rhythms 6.