What is the proper technique for administering effective Cardiopulmonary Resuscitation (CPR)?

How to Give Effective CPR

Immediately begin high-quality chest compressions at a rate of 100-120 per minute with a depth of at least 2 inches (5 cm) for adults, allowing complete chest recoil between compressions, and minimize any interruptions in compressions. 1, 2

Initial Assessment and Activation

Scene Safety and Recognition:

• Ensure the scene is safe before approaching 3, 1
• Check for responsiveness by shouting and tapping the victim 1, 2
• Simultaneously look for absent or abnormal breathing (only gasping) and check for a pulse within 10 seconds 3, 1, 2
• Critical pitfall: Treat victims with occasional gasps as if they are not breathing—gasping is a sign of cardiac arrest, not effective breathing 3

Emergency Activation:

• If unresponsive with no pulse or only gasping, immediately activate the emergency response system (call 911) 1, 2
• Send someone to retrieve an AED while you begin CPR, or if alone with a cell phone, activate emergency services first then start CPR 3
• If alone without a cell phone, perform 5 cycles of CPR (approximately 2 minutes) before leaving to call for help 3

High-Quality Chest Compressions

Compression Technique for Adults:

• Position the patient supine on a firm surface 3, 4
• Place the heel of one hand on the center (lower half) of the sternum, with the other hand on top, fingers interlaced 3, 4
• Position yourself with arms straight and perpendicular to the patient's chest 4
• Push hard and fast: Compress at least 2 inches (5-6 cm) deep at a rate of 100-120 compressions per minute 1, 2, 4
• Allow complete chest recoil after each compression—incomplete recoil prevents cardiac refilling and reduces blood flow 3, 2, 5

Critical Quality Metrics:

• Minimize interruptions in compressions to less than 10 seconds 3, 1, 6
• Achieve at least 60 actually delivered compressions per minute (accounting for pauses) 4
• Change compressors every 2 minutes to prevent fatigue and maintain compression quality 1, 6, 2
• Common pitfall: Healthcare providers often spend too long checking for pulses (>10 seconds), delaying critical compressions 2

Airway and Ventilation

For Trained Rescuers:

• After 30 compressions, open the airway using head tilt-chin lift maneuver 3
• If trauma or spinal injury is suspected, use jaw thrust without head tilt; however, if this fails to open the airway, use head tilt-chin lift because maintaining a patent airway is the priority 3
• Deliver 2 breaths over 1 second each, giving sufficient volume to produce visible chest rise 3
• Avoid excessive ventilation (too many breaths or too large a volume) as this is harmful 3

For Untrained Rescuers:

• Provide compression-only CPR without rescue breaths 3, 1, 2
• High-quality evidence shows: Compression-only CPR by untrained bystanders improves survival to hospital discharge by 2.4% compared to interrupted compressions with rescue breathing (14% vs 11.6% survival) 7

Compression-to-Ventilation Ratios:

• Single rescuer: 30 compressions followed by 2 breaths 3, 1
• Two healthcare providers: 30 compressions to 2 breaths for adults; 15 compressions to 2 breaths for children 3
• Once an advanced airway is placed: Continuous compressions at 100-120/minute with asynchronous ventilations at 1 breath every 6 seconds (10 breaths/minute) 3, 1, 6

Defibrillation

AED Use:

• Apply the AED as soon as it becomes available 3, 1, 2
• Turn on the AED and follow voice prompts 3
• Minimize interruptions: Apply pads without stopping compressions if possible 3
• When a shock is advised, clear the patient, deliver one shock, and immediately resume CPR starting with chest compressions 3, 6
• Do not check pulse or rhythm immediately after shock delivery—this wastes critical time 6
• Continue CPR for 2 minutes (5 cycles) before the next rhythm check 3, 6

Pediatric Considerations

Infants (Under 1 Year):

• Use 2-finger technique: Place 2 fingers just below the intermammary line 3
• For 2 rescuers: Use 2-thumb encircling hands technique (preferred method) 3
• Compress at least one-third the anterior-posterior diameter of chest (approximately 1.5 inches or 4 cm) 3

Children (1 Year to Puberty):

• Use 1 or 2 hands depending on child size and rescuer strength 3
• Compress at least one-third the anterior-posterior diameter (approximately 2 inches or 5 cm) 3
• Single rescuer: 30:2 compression-to-ventilation ratio 3
• Two rescuers: 15:2 compression-to-ventilation ratio 3

Important pediatric note: Because most pediatric arrests are asphyxial (due to respiratory failure), ventilations are critical for children—compression-only CPR is less effective in pediatric patients than in adults 3

Rhythm and Pulse Checks

Timing:

• Check rhythm every 2 minutes during CPR 1, 6
• Spend no more than 10 seconds checking for a pulse 3, 2
• If no definite pulse is felt within 10 seconds, immediately resume compressions 3

Workflow:

• Perform rhythm check at 2-minute intervals after completing compression cycles 6
• If organized rhythm is present, briefly check for pulse 6
• If any doubt exists about pulse presence, resume chest compressions immediately 6
• Change compressors at the time of rhythm checks to maintain quality 6

Special Circumstances

In-Hospital Cardiac Arrest:

• Activate the bed's "CPR mode" to increase mattress stiffness 3
• Use a backboard to improve compression depth 3

Suspected Opioid Overdose:

• If pulse present but no normal breathing: Provide rescue breathing at 1 breath every 6 seconds and administer naloxone if available 1, 2
• If in cardiac arrest: Standard CPR takes priority over naloxone administration 1

Critical Pitfalls to Avoid

• Delaying compressions: Do not spend more than 10 seconds checking for pulse 3, 2
• Excessive interruptions: Each pause decreases coronary and cerebral perfusion pressure, reducing survival 6, 5
• Inadequate depth or rate: Compressions must be at least 2 inches deep at 100-120/minute for adults 1, 2
• Incomplete chest recoil: Leaning on the chest between compressions prevents cardiac refilling 3, 2
• Checking rhythm after shock: Resume compressions immediately after defibrillation without checking pulse 6
• Excessive ventilation: Too many or too large breaths are harmful during CPR 3