Updated Feb 2019
Based on the latest curriculum published by the American Red Cross. (also see our current AHA CPR Guidelines )
American Red Cross. (2014, January 1). American Red Cross First Aid/CPR/AED Participant’s Manual. Retrieved January 28, 2015 *
The American Red Cross (ARC), American Heart Association (AHA), American Safety and Health Institute (ASHI), as well as most other organizations that create CPR courses base their programs on the Consensus on Science for CPR and Emergency Cardiovascular Care which was last published in 2010. It is expected that a revised version will be released in 2015 or 2016 which may cause changes for all CPR courses. Despite each of the major organizations using the same body of research for their courses there are still slight differences based on the individual recommendations of the organizations subject matter experts most of whom are Doctors, Paramedics, and Nurses. The purpose of this review is to outline the approach dictated by the American Red Cross.
Cardiac Chain of Survival
To have the best chance of recovering from a cardiac arrest the ARC advises that individuals should follow the Cardiac Chain of Survival. The chain starts with early recognition of cardiac arrest and immediately upon recognition activation of Emergency Medical Services with a rapid response from them. The second link in the chain is CPR provided by those on scene with the victim immediately at the time of collapse. The third link is early defibrillation, when appropriate, by quick use of an AED by bystanders. The final link is early advanced care as provided by Emergency Medical Services and then a hospital with the capability of correcting the problem which led to the cardiac arrest.
Time is critical in a cardiac arrest because each minute that someone goes without CPR and use of an AED their best chance of survival decreases by 10%.
The signs of cardiac arrest which the ARC teaches people to recognize are unconsciousness and an absence of breathing. This is a notable difference between the ARC and the AHA who also teach that any abnormal breathing, such as the gasping breaths that occur shortly before death, are also signs of cardiac arrest and need to be treated accordingly. Research has shown that bystanders mistake abnormal but inadequate breathing for acceptable breathing and do not identify the victim as being in cardiac arrest.
The ARC uses the mnemonic “Check, Call, Care” for their process of aiding an individual who has collapsed. The process begins with checking the scene for safety and checking the victim to see if they are in fact unconscious. The next step is to call for emergency medical services, then to check for breathing, then check for severe bleeding, then provide care in the form of CPR for someone who is not breathing.
CPR begins with moving the victim to a firm flat surface, if they are not already on one, and then kneeling beside the victims upper chest while placing your hands on the breast bone and beginning compressions.
Compressions can be given with or without breathing. It is best to breathe for the patient but if you are unable or unwilling to do so it is acceptable to provide high quality compressions only. Regardless of if you decide to breath for the patient or not the process of providing compressions is the same. One hand should be placed on the breast bone in the center of the chest, your second hand should be placed on your first while keeping your fingers off the chest, and maintaining your shoulders in position over your hands. When you push down you should do so at a smooth and steady rate of at least 100 compressions per minute. For adults your compressions should go down at least 2” using the weight of your upper body to make this possible. Using your arms only will result in rapid fatigue and poor compressions.
If you will be breathing for the patient provide 2 breaths after giving 30 compressions. Start by tilting the head back and lifting the chin to open the victim’s airway and then provide the first breath over 1 second looking to see the victim’s chest rise. If the chest does not rise with the first breath re-tilt the head and give a second breath. If this fails as well provide another 30 compressions after which open the victims mouth and look to see if there is a foreign object blocking the airway. If you see the object attempt to remove it and then provide another two breaths still looking for chest rise as the indicator you were successful.
Your cycle of 30 compressions and 2 breaths will continue until the victim shows obvious signs of life such as breathing (or the victim complaining about you doing compressions), a higher trained responder or professional rescuer takes over, you become too exhausted to continue and there is no one else there to assist, or should the scene become unsafe. If an AED becomes available that should be used immediately while minimizing the interruption in CPR.
CPR for an Infant
If providing CPR for an infant the ratio of compressions to breaths remains the same but the method of performing compressions changes. For an infant you should use 2-3 fingers in the center of the chest on the lower half of the breast bone to compress the chest about 1 ½”. Effective rescue breaths are still indicated by chest rise but remember you may need to use much less air to achieve the same effect in an infant.
Automatic External Defibrillator (AED)
Using an AED is an important part of the cardiac chain of survival. High quality CPR will ensure that oxygen continues to get to the brain but will not restart the heart. An AED may be reorganize the electrical activity in the heart and help it start beating again. An AED is a sophisticated computer which analyzes the heart to see if it will benefit from an electrical shock. The way the AED is able to analyze and shock the heart is through patches that the rescuer must apply to the victims bare chest. Rescuers should ensure that the chest is dry and if there is a medication patch on the chest it should be removed with a gloved hand. Ideally a second bystander will be able to use the AED while the first bystander continues CPR. Whoever is using the AED should place it next to the victim, turn it on and listen to the voice prompts that will follow. The AED will advise you to apply the patches, connect them to the AED, and stand clear to allow the AED to analyze the heart. During analysis CPR and any other movement must be stopped. The AED will state that either a shock is advised or it is not. If it is not advised immediately start CPR again but if a shock is advised ensure that you and all other bystanders are not touching the victim.
Being in contact with a person while they are defibrillated could result in a shock being conducted to the rescuer. As soon as the shock has been delivered CPR should be immediately started. There is no risk to the rescuer after the shock has been delivered, only while the shock is being delivered. Some AEDs will have patches for adults and for children. The patches are clearly marked and only adult pathches should be used on adult patients. Patches for children are not only physically smaller but actually tell the AED to deliver a smaller shock which may not be beneficial for an adult. Child patches should be used on those 8 years or younger or weighing less than 55lbs.
By following the guidelines set forth by the American Red Cross you can help save someone’s life should they suffer a cardiac arrest. Remember “Check, Call, Care”.
Check the scene and the victim
Call for Emergency Medical Services
Check for breathing
Check for severe bleeding
Care for the victim
Seek out your local CPR training center to get a hands on class to better learn CPR and watch for changes in CPR within the next year or two.
|Hand Position||2 hands center of chest, lower half of breast bone||2 hands center of chest, lower half of breast bone||2-3 fingers in the center of the chest, lower half of the breast bone|
|Compression Depth||At least 2”||About 2”||About 1 ½”|
|Breathing||Look for Chest RiseDeliver breaths over 1 second||Look for Chest RiseDeliver breaths over 1 second||Look for Chest RiseDeliver breaths over 1 second|
|Compressions to Breaths||30:2||30:2||30:2|