What alternative can be used in a clinic setting if an Automated External Defibrillator (AED) is not available?

Immediate CPR is Your Alternative to an AED

If your clinic does not have an AED, immediately begin high-quality cardiopulmonary resuscitation (CPR) with chest compressions at a rate of at least 100-120 compressions per minute and a depth of at least 2 inches (5 cm) in adults, while simultaneously activating emergency medical services (EMS) by calling 9-1-1. 1

Core Resuscitation Algorithm Without an AED

Immediate Recognition and Activation

• Recognize cardiac arrest by checking for unresponsiveness and absent or abnormal breathing (only gasping) 1
• Activate EMS immediately (call 9-1-1) and put the phone on speaker so you can receive dispatcher guidance while performing CPR 1
• Do not waste time checking for a pulse if you are not a trained healthcare provider—if the person is unresponsive and not breathing normally, assume cardiac arrest 1

High-Quality Chest Compressions (The Foundation)

Chest compressions are the single most critical intervention you can provide without an AED. 1

• Start compressions immediately using the C-A-B sequence (Compressions-Airway-Breathing) rather than the old A-B-C approach 1
• Compression rate: At least 100-120 per minute 1, 2
• Compression depth: At least 2 inches (5 cm) in adults 1
• Allow complete chest recoil after each compression—do not lean on the chest 1
• Minimize interruptions in compressions to less than 10 seconds, as any pause reduces coronary perfusion pressure and survival 1, 2
• Switch compressors every 2 minutes if multiple rescuers are available to prevent fatigue 1

Adding Rescue Breaths (If Trained)

• If you are trained in CPR: Use a 30:2 compression-to-ventilation ratio (30 compressions followed by 2 rescue breaths) 1
• If you are untrained or uncomfortable with rescue breathing: Perform continuous chest compressions without pauses (hands-only CPR) 1
• Each rescue breath should take approximately 1 second and make the chest visibly rise 1
• The median interruption for 2 ventilations should be 7 seconds or less, though pauses up to 10 seconds are acceptable 3

Critical Distinction: When Compressions Alone Are Sufficient vs. When Breaths Are Essential

For adults with sudden witnessed collapse (likely cardiac cause such as ventricular fibrillation), chest compressions alone are nearly as effective as compressions plus breaths, making hands-only CPR acceptable for untrained rescuers 1

However, for children, infants, or suspected asphyxial arrest (drowning, choking, drug overdose), rescue breaths are more important because the arrest is respiratory in origin—optimal CPR includes both compressions and ventilations 1

What CPR Accomplishes Without Defibrillation

Physiological Benefits

• CPR prolongs ventricular fibrillation and delays its deterioration to asystole, extending the window during which defibrillation can be successful when EMS arrives 1
• CPR provides critical circulation to the heart and brain, delivering oxygen and metabolic substrates that increase the likelihood of successful resuscitation 1
• Bystander CPR can double or triple survival from witnessed cardiac arrest, even without immediate defibrillation 1
• When bystander CPR is provided, survival rates decrease by only 3-4% per minute (compared to 7-10% per minute without CPR) 1

Realistic Expectations

• CPR alone is unlikely to terminate ventricular fibrillation and restore a perfusing rhythm—defibrillation is ultimately needed for shockable rhythms 1
• However, CPR maintains viability until advanced care arrives, and for non-shockable rhythms (pulseless electrical activity, asystole), CPR is the primary intervention alongside treating reversible causes 1, 2

Continue CPR Until EMS Arrives

Do not stop CPR until one of the following occurs: 1

• EMS personnel arrive and take over
• An AED becomes available and is ready to analyze the rhythm
• The patient shows obvious signs of life (breathing normally, moving purposefully)
• You are physically unable to continue due to exhaustion
• The scene becomes unsafe

Common Pitfalls to Avoid

Inadequate Compression Quality

• Compressions that are too shallow (less than 2 inches) are ineffective—push hard 1
• Compressions that are too slow (less than 100/minute) provide inadequate circulation 1
• Leaning on the chest between compressions prevents venous return and reduces cardiac output 1

Excessive Interruptions

• Prolonged pauses for pulse checks, rhythm assessment, or rescue breaths dramatically reduce survival 1
• Limit pulse checks to no more than 10 seconds 1
• If giving rescue breaths, keep ventilation pauses to less than 10 seconds 3

Fear of Causing Harm

• The risk of injury from CPR is low (rib/clavicle fractures occur in only 1.7% of cases, with no visceral injuries typically reported) 4
• The benefit of providing CPR vastly outweighs any potential risk—doing something is always better than doing nothing 4
• Even if you are uncertain whether the person is in cardiac arrest, if they are unresponsive and not breathing normally, start CPR immediately 1

Dispatcher-Guided CPR

• Follow the 9-1-1 dispatcher's instructions if you are uncertain about technique 1
• Dispatchers are trained to provide real-time CPR guidance and can help you maintain proper compression rate and depth 1
• Keep the phone on speaker so you can hear instructions while performing CPR 1

Special Considerations for Clinic Settings

If You Suspect Opioid Overdose

• Administer naloxone if available while continuing CPR, as opioid-induced respiratory arrest can lead to cardiac arrest 1
• Emphasize rescue breathing in addition to compressions, as the arrest is respiratory in origin 1

If Multiple Staff Members Are Present

• Assign roles immediately: one person performs compressions, another provides rescue breaths (if trained), and a third calls 9-1-1 and retrieves any available emergency equipment 1
• Rotate compressors every 2 minutes to maintain compression quality 1

Documentation and Follow-Up

• After the event, document the cardiac arrest, duration of CPR, and outcome 4
• Consider acquiring an AED for your clinic, as early defibrillation within 3-5 minutes of collapse is the definitive treatment for ventricular fibrillation 1