What are the basic rules of cardiopulmonary resuscitation (CPR)?

Basic Rules of CPR

The fundamental approach to CPR begins with ensuring scene safety, followed by immediate activation of emergency services, and then performing high-quality chest compressions at a rate of 100-120 per minute with a compression-to-ventilation ratio of 30:2 for single rescuers or 15:2 for two rescuers in pediatric patients. 1

Initial Scene Assessment and Activation

• Verify scene safety before approaching the victim to protect yourself and others from potential hazards 1, 2
• Check for responsiveness by tapping the victim and shouting for help 1, 2
• Activate the emergency response system immediately by calling 9-1-1 (or your local emergency number) 1, 3
  • If alone with a cell phone: call 9-1-1 first, then begin CPR 1
  • If alone without a cell phone: perform 5 cycles of CPR (about 2 minutes), then call 9-1-1 1
  • If help is available: send someone to call 9-1-1 and retrieve an AED while you start CPR 1

Assessment of Breathing and Pulse

• Look for no breathing or only gasping while simultaneously checking for a pulse within 10 seconds 1, 2
• If pulse is present but no normal breathing: provide rescue breathing at 1 breath every 2-3 seconds (20-30 breaths per minute) and reassess pulse every 2 minutes 1, 2
• If heart rate is less than 60 beats per minute with signs of poor perfusion: start CPR immediately 1, 3
• If no pulse or no normal breathing: begin CPR immediately 1

High-Quality Chest Compressions

Compression Technique

• Push hard and fast at a rate of 100-120 compressions per minute 1, 2
• Compress at least one-third of the anterior-posterior diameter of the chest 1, 2
  • For adults: approximately 2 inches depth
  • For children: approximately 2 inches depth 1
  • For infants: approximately 1.5 inches depth 1, 2
• Allow complete chest recoil after each compression without leaning on the chest 1, 2
• Minimize interruptions in chest compressions to maintain perfusion 1, 2

Hand Positioning

• For adults and children: compress in the center of the chest (lower half of the sternum) 1
• For infants: compress just below the intermammary line using the 2-finger technique for single rescuers, or the 2-thumb encircling hands technique when two rescuers are present 1, 2

Compression-to-Ventilation Ratios

• Single rescuer: perform cycles of 30 compressions followed by 2 breaths 1, 3
• Two rescuers (pediatric patients): perform cycles of 15 compressions followed by 2 breaths 1, 3
• Change compressors every 2 minutes or sooner if fatigued to maintain compression quality 1, 2

Airway and Ventilation

• Open the airway using a head tilt-chin lift maneuver 2
• Deliver 2 breaths after each set of compressions, ensuring each breath makes the chest rise 1
• Each breath should last about 1 second with visible chest rise 1

Use of Automated External Defibrillator (AED)

• Use the AED as soon as it arrives at the scene 1
• Follow AED prompts for rhythm analysis and shock delivery 1
• If shockable rhythm detected: deliver 1 shock and immediately resume CPR for 2 minutes 1
• If non-shockable rhythm: continue CPR for 2 minutes before allowing rhythm recheck 1

Optimal CPR Surface

• Perform chest compressions on a firm surface whenever possible 1
• In hospital settings: activate the bed's "CPR mode" to increase mattress stiffness, or use a backboard to improve compression depth 1

When to Continue or Stop CPR

• Continue CPR until:
  • Advanced life support providers arrive and take over 1
  • The victim starts to move or shows signs of recovery 1
  • You are too exhausted to continue 1
  • The scene becomes unsafe 1

Critical Pitfalls to Avoid

• Inadequate compression depth: ensure you compress at least one-third of chest diameter 2, 3
• Excessive interruptions: minimize pauses in compressions to less than 10 seconds 1, 2
• Incorrect compression rate: maintain 100-120 compressions per minute, not faster or slower 1, 2
• Incomplete chest recoil: allow full chest expansion between compressions 1, 2
• Delayed activation of emergency services: call for help immediately, not after attempting CPR 1, 3
• Rescuer fatigue: rotate compressors every 2 minutes to maintain quality 1, 2