AHA CPR Guidelines 2020 -

AHA CPR Guidelines 2020

AHA official guidelines for CPR –  Updated Jan 2020

The American Heart Association (AHA) is a non-profit organization committed to fighting cardiovascular disease and the effects of it including cardiac arrest. Through an ongoing process the AHA reviews all available research regarding cardiopulmonary resuscitation (CPR), First Aid, and Advanced Life Support efforts utilized by healthcare providers. The result of this process is a series of patient care guidelines and improved curriculums for the courses they offer. Although the recommendations are coming from a United States based organization they are based on research from across the world. The most recent report is from 2015 Here are some of the key points, with a focus on the recommendations for the average rescuer, not healthcare providers.

Immediate recognition and reaction to cardiac arrest

Time is critical when someone’s heart has stopped and any delay in starting resuscitation efforts could cost that person their life. History has shown that sometimes an individual in or nearing cardiac arrest may gasp or exhibit significantly abnormal breathing either of which is insufficient to sustain them. That breathing has been mistaken by bystanders as sufficient and CPR was delayed until professional responders arrived. The new guidelines stress the importance of recognizing the signs of cardiac arrest and taking action rapidly.

The ABCs becomes CAB

In the past the process of assessing and rendering aid started with addressing the patient’s Airway, then their Breathing, and finally their Circulation giving rise to the ABC approach. The current process still incorporates those three elements, but in the order of CAB Circulation, then Airway, and then Breathing. Addressing a lack of circulation through compressions is more important initially than addressing airway or breathing. The AHA estimates that the change only delays breathing for a patient by 18 seconds, but dramatically improves how soon compressions start. Now someone immediately provides thirty chest compressions, then tilts the head to open the airway, then gives two breaths. The current guidelines have removed the practice called Cricoid Pressure which involved a rescuer applying pressure to the patient’s windpipe while breathing for them with the hope of decreasing the amount of air that entered the stomach. Research has shown this practice is difficult to teach to rescuers and may not make the difference it was once thought to. For those reasons Cricoid Pressure is no longer recommended. 

Streamlined process for providing CPR

Barriers and complications to starting CPR have been removed with the hope of encouraging bystanders to act more quickly. One of the changes was removing the old “Look, Listen, and Feel” process and continuing to insist that lay rescuers do not check for a pulse. Lay rescuers and even experienced healthcare providers may have a hard time finding a pulse and spend too long looking for one before starting CPR. It is far better for someone to have CPR and not need it than go without CPR when it is desperately needed.

Continued emphasis on high quality CPR

Not only must CPR be started quickly it must also be good enough to benefit the patient. For untrained rescuers or those unwilling/unable to provide breaths excellent compressions provided continuously without breaths is highly desired. Compressions, with or without breathing, should be hard and fast and done in the middle of the chest. They should be at a rate of at least 100/min and the depth of them must be at least 2 inches. The new depth is only a slight change from the previous 1 ½ to 2 inches but by encouraging people to compress the chest at least 2 inches there is a greater likelihood that each compression will pump more blood to the brain, heart, and other organs. Providing one number to work towards is part of the AHA’s effort to simplify the process and in turn improve the overall outcome for patients.

The new overall process is this:

As soon as an emergency is recognized someone should call for help and get an AED.

If the victim is not responding to rescuers and does not appear to be breathing normally, CPR should be started.

  • CPR begins with compressions delivered hard and fast in the middle of the victims chest. The rescuer should place the heel of one hand on the center of the victim’s chest and the other hand right on top of the first with fingers intertwined.
  • Each compression should be at least 2” deep and delivered at a rate of at least 100/minute. After giving 30 compressions a rescuer who is able to breathe for the victim should do so. If a rescuer is unable to breathe for the victim they should provide continuous high quality compressions until professional rescuers arrive.
  • Breaths for the victim start by adjusting their airway. Tilt the victim’s head by the forehead back and lifting the chin to open the airway. Pinch shut the victim’s nose using the forefinger and thumb.
  • Each breath given to the victim should be a normal breath for the rescuer and delivered over 1 second while looking for the victims chest to rise.
  • A total of two breaths should be given to the patient and then the rescuer should immediately start chest compressions again.
  • The cycle of 30 compressions and 2 breaths should be continued until the rescuer is physically unable to do so or professional rescuers arrive.
  • As soon as an AED becomes available it should be turned on and its instructions followed to connect it to the patient. An AED will only work on someone who will benefit from it and will not harm someone who will not benefit from it.

As more research is conducted about the human body and the ways we treat problems associated with it the CPR standards will likely continue to evolve. It is important for individuals to stay current by renewing their CPR certification every 2-3 years as recommended by the organization issuing the CPR certification. Taking a class on a regular basis also helps to develop the skills and knowledge that must be immediately used during an emergency. At least 88% of cardiac arrests happen outside of hospitals so there is a high likelihood that an average citizen will be the first one on scene and may even be able to save that persons life. Encourage your friends and family to get certified because the life they save may be yours!

What do you think about this post? Share your thoughts in our comments section.


  1. Avatar
    January 13, 2014 11:45 Reply

    Hi, I am working as BLS-ASCLS instuctor in Sagar hospitals, Bangalore since 2yrs. Since all the nursing staff cannot take ACLS course instantly due to staffing problem, I am giving orientation of ACLS & PALS when the staff come for BLS in order to get used to crash trolley items. Periodically I am checking for updates and I found the above mentioned information is also useful for the staff to learn well. Thanks for this information.
    HVSM, AHA-BLS & ACLS Instructor

    • Lisa Madison
      January 13, 2014 23:41 Reply

      thank you for dropping by. I appreciate that. keep coming back 🙂

    • Avatar
      Chaitra { floor marketing executive }
      June 07, 2016 11:23 Reply

      hai sir , we the S&G Academy provides AHA accredited BLS and ACLS programme with certificates at your convenience and negotiable price ..please reply to our mail if staffs are interested.

  2. Avatar
    azadehjou abbas
    January 13, 2014 15:45 Reply

    not shocble cardiac arrest and treatment

  3. Avatar
    February 14, 2014 16:23 Reply

    I was wondering when the rescue breaths are going to be shortened. Useful info and very applicable and practical as well.

  4. Avatar
    February 15, 2014 01:11 Reply

    Hi there. I’ve been oriented then from my nursing school that the rescuer must first ask the victim if she’s OK before asking somebody to call 911. So now calling 911 must come first before making the victim respond. Thanks.

  5. Avatar
    Lawrence Lee
    February 20, 2014 07:15 Reply

    Is that any tutorial video for it? 🙂

  6. Avatar
    March 13, 2014 11:29 Reply

    Rajasekharan Nair,
    Public Safty Instructor,(FAST)
    Indian Institute of Emergency Medical Service.
    :Hands on CPR will very effective for General People :

  7. Avatar
    March 13, 2014 11:35 Reply

    Indian Institute of Emergrency Medical Service Conducting First Aid and Safty training programme (First Responder Course) at all states of India for Govt. Organisations, Schools, Colleges, etc since 2004.

  8. Avatar
    March 14, 2014 10:59 Reply

    I have been told by my instructor the compression to breath rate is now 30 to 1 however, everything in every book show this as 30 to 2. Which is correct please?

    • Avatar
      kim fawkes
      March 20, 2014 10:45 Reply

      Hi Ellen
      The Australian Resuscitation Council still recommends 30:2. I don’t know where your instructor (what are their qualifications and experience?) got 30:1 from, though they may be thinking that breathing has little value in resuscitation because the average person still has oxygen in their body from normal ventilation. I can see a time in the future where breaths are discarded completely in favour of compressions only for the lay person though the emergency services may still give supplementary oxygen via a mask, cheers Kim

    • Avatar
      July 09, 2014 07:11 Reply

      30:2 is correct.

  9. Avatar
    kim fawkes
    March 16, 2014 12:03 Reply

    G’day I’m a first aid trainer and I am still being told to teach my students DRSABCD. But you indicate we should do DRSCABD. Is that right? I don’t know if the Australian Resuscitation Council will be passing this onto us but in any event, it seems that I should now put compressions ahead of checking the airway and doing two breaths. I have been advising my students of this change in CPR practice and they also query why they should have to do two breaths when it has been shown that breathing into an unconscious person’s lungs don’t really do that much, that the fact the person was breathing minutes ago means they should have enough oxygen in their body. Cheers, Kim

  10. Avatar
    Hari krishna
    March 19, 2014 02:19 Reply

    Rescue breaths are given 30:2.
    1) Are these breaths given only for 2 seconds duration each or more. If so whats the duration.
    2) What is the interval or gap between 2 breaths.
    3) Does the duration of each breath varies in children and adults. If so, please mention.

    • Avatar
      kim fawkes
      March 20, 2014 10:39 Reply

      G’day, there is no real duration of breaths. As soon as you finish one, you give the other, making sure you look and feel for the rise and fall of the chest before repeating this action. Breathing into a child or adult’s mouth is pretty much the same (pinch their nostrils, seal their mouth with yours or use a face shield mask) as you will need to give two quick breaths whereas with an infant you only give two puffs so as to not hyper-inflate their lungs. It is interesting that the AHA recommends chest compressions ahead of breaths as the whole process of checking the airway and breathing wastes valuable time that could be better spent on compressing the heart even though this method only increases cardiac output by about a third compared with normal heart function.

      I hope this answers your question.

  11. Avatar
    March 26, 2014 02:58 Reply

    Really Informative for the update. Thxs a lot

    • Avatar
      kim fawkes
      March 28, 2014 10:37 Reply

      Hi, I know that pushing down on the chest is how one does compressions to simulate the heart’s contraction and relaxation phase so when you say Airway – Breathing – Chest, don’t you mean Airway – Breathing – Compressions? Compressions are more important than airway and breathing if the casualty is in life thtreat, i.e. cardiac arrest, but if they are unconscious from an epileptic seizure for example and are breathing and have a strong pulse then there would be no need for compressions so airway and breathing would be more applicable here. Cheers Kim

      n’t in life threat and had Cheers Kim

  12. Avatar
    May 22, 2014 01:16 Reply


    • Avatar
      kim fawkes
      May 25, 2014 10:52 Reply

      Hello My understanding is based on the current Australian Resuscitation Guidelines. D – Danger, Response – do they respond? Are they conscious/unconscious? If unconscious or they require additional medical assistance, then S – Send for help, cheers Kim

  13. Avatar
    July 08, 2014 10:30 Reply

    For training purposes always insist that the learner uses his or her own PVC mouth piece with a non return valve. What usually happens is that if a learner is suffering from a contagious disease such as TB he or she may pass the bacterium through the mouth piece into the dummy and the next person can do the same if they are a sufferer until there is a build up of TB sputum in the lungs of the dummy . When chest compressions are performed the contaminated sputum is ejected back to the mouth area and there is a danger of the learner who is not a sufferer of TB or if he or she is not using a non return valve mouth piece can be infected realising that TB is spread by the contaminated sputum from one to another. Take care and be safe.

  14. Avatar
    July 09, 2014 05:12 Reply

    Hellow , Indian Institute of Emergency Medical Services conducting BLS, ACLS, PALS, ATCN, AREMT, BDLS, ADLS Courses since 2005. We also conducting First Responder level courses for police Force, Fireforce, Motor Vehicle Department, Schools, Colleges, Residential Associations, Charitable Trusts etc.

    • Avatar
      jitendra sharma
      June 28, 2017 05:52 Reply

      gud job sir ….can you give me your contect no….

  15. Avatar
    July 09, 2014 13:07 Reply

    My friend died two days ago after he collapsed at our school. I was in the building, but no one made me aware this was happening at the time. No one performed CPR. I guess no one knew. I was certified long time ago, but let it expire. I would have done something. At least the compressions. Maybe it was his time to die, but I would have tried! My goal is to get people in our school building to get certified in CPR. No shift in our school should be without at least one person knowing CPR. I am devastated that I was not given a chance to save my friend when compressions alone might have saved him.

    • Lisa Madison
      July 10, 2014 00:21 Reply

      Miki, I am so sorry for your loss. Yes i think trained and certified people can really help save lives. You should try to educate more about the importance of getting CPR training

  16. Avatar
    August 01, 2014 14:49 Reply

    Thank you for the updates…just some clarifications for Pediatric resuscitation as its said the most common cause of cardiac arrest in children is hypoxia does the new recommendations imply studies have shown hypoxia is no more the primary problem in children and now the emphasis switch to Circulation.

    And CAB approach with upfront chest compression-does is apply to all patients even those with palpable reasonable pulses i.e. >60/min for example you have unconscious child with no spontaneous breathing but palpable pulse>60/min do you straight go for Chest compression

  17. Avatar
    Martin Wilson
    August 01, 2014 15:02 Reply

    Is the AHA still recommending that a professional health worker such as a registered nurse palpate for a pulse before commencing cardiac compressions ?.

  18. Avatar
    Martin Wilson
    August 01, 2014 15:06 Reply

    Does the AHA recommend that a professional health care worker such as a registered nurse palpate for a pulse before commencing cardiac compressions ?. Thank you.

  19. Avatar
    February 10, 2015 20:42 Reply


    In the CPR of adults its goes, “Check whether the victim is responding or breathing” and then check for heart pulse. i dont get why is breahing befeor checking the heart-pulse.

    When the main guide line is “If you dont feel heartpulse there is no breathing.”

    i will be very happy for a full answer.

    Thanks 🙂

    • Lisa Madison
      February 12, 2015 02:05 Reply

      Checking for a pulse has been found to be unreliable, even with trained rescuers, and as a result has been de-emphasized and removed in some cases. If someone is unconscious and not breathing normally there’s a likelihood that they require CPR. Someone can exhibit gasping, or agonal, breathing which is not adequate to support life but may be mistaken by a rescuer for a sign of life delaying the start of CPR.
      If a pulse check is done and the rescuer correctly feels that there is not a pulse the patient will not be breathing.

  20. Avatar
    March 02, 2015 07:54 Reply

    Is the NCLEX-RN updated on this new guidelines? I mean choosing Circulation first instead of Airway but the old NCLEX-RN has not been changed…

  21. Avatar
    March 31, 2015 00:56 Reply

    I have a question. In the paragraph “Streamlined process for providing CPR”, is the last sentence correct? After reading the entire piece, it seems that it should read,” It is far worse for someone to go without CPR when it is desperately needed than to have CPR and not need it. It seemed confusing and I wondered if I was missing something.
    Thanks for your reply.

  22. Avatar
    Luis C. Banez III
    May 06, 2015 15:59 Reply

    Hi! this is Luis from the Philippines, just want to ask, ” if I performed Head tilt Chin lift, then deliver the first blow and did not go in, I will re tilt, if the second blow goes in, Am I going to give another second blow?

    • Avatar
      kim fawkes
      May 10, 2015 11:39 Reply

      Hi Luis
      Not sure what you mean by “blow”. Are you referring to breathing, that is, the first rescue breath? If so, procedure is (for adult and child) is Head Tilt, Chin LIft, Jaw Support. Casualty’s mouth should be open. Pinch their nostrils, place your mouth (or resuscitation mask) over casualty’s mouth and give one strong breath (better word than blow). If casualty’s chest does not rise, check for obstruction in mouth (vomit, etc) and if present, remove by scooping out with finger. Return to Head Tilt, Chin Lift, Jaw Support and repeat procedure. Check for casualty’s chest movement which is a sign your breathing technique is successful

  23. Avatar
    Dr Mohd. Tofazzal Hossain
    May 25, 2015 04:52 Reply

    CPR (BLS, ACLS, PALS, ATLS) are essential tools for life support in all places all over the world. It should free on line programm including vidio clips.

  24. Avatar
    Dr. Supratim Karmakar
    May 25, 2015 13:35 Reply

    I think u need to mention that during CPR, 5 cycles are given continously over a period of 2 mins. Thus, 1 cycle= 24 sec ( 30 chest compressions withn 18 sec/ 2Breaths within rest 6 secs) while ensuring within the whole span that airway is open by neck extension i.e. By head/chin lift and if that is C/I, then by Jaw Thurst.. Just a thought. Thank you..

  25. Avatar
    Dr. Supratim Karmakar
    May 25, 2015 13:44 Reply

    Well My earlier advice was for while doing BLS and not for ACLS.. During ACLS chest compressions must be stopped and shud be given at a rate of 100/min independently of ventilation which is given @ 8-10/min by bag/ ventilator. Thank u..

    • Avatar
      Dr. Supratim Karmakar
      May 25, 2015 19:06 Reply

      During acls Chest compressn must not be stopped… Sorry typing mistake

  26. Avatar
    September 01, 2015 05:08 Reply

    Hi this is Steffy, doing my masters in pediatric nursing and i gotta give a presentation on acls according to the 2015 guidelines, so i just wanted to know if there are just three changes
    ABC to CAB
    chest compressions of 100/min and the depth at least 2 inches and
    immediate starting of the chest compressions rather than first the look,listen,feel process.

    Am i right ?

Leave a reply