Cardiac arrest strikes without warning, claiming over 350,000 lives annually in the United States. Recent data show that survival to hospital discharge after out-of-hospital cardiac arrest is only 10.5%, with favorable neurologic survival at 8.2%. However, immediate action can dramatically change these outcomes. When bystanders perform CPR before emergency services arrive, survival rates increase significantly—16.0% versus 4.5% for unwitnessed arrests.
Mastering CPR is not just a skill—it’s the difference between life and death. This comprehensive guide covers essential techniques, correct compression ratios, and the critical role of automated external defibrillators in sudden cardiac arrest scenarios.
How to Perform CPR: The CAB Approach
The modern approach to CPR follows the CAB sequence: Compressions, Airway, and Breathing. The 2025 American Heart Association Guidelines emphasize high-quality chest compressions, early defibrillation, and integration of advanced resuscitation techniques.
Step-by-Step CPR Technique
- First, assess the scene for safety. Check if the person is responsive by tapping their shoulder and asking loudly if they’re okay. If there’s no response and the person isn’t breathing normally or is gasping, cardiac arrest has occurred.
- Call 911 immediately. If you’re alone, use your mobile phone in speaker mode so you can begin CPR while staying connected with emergency services.
- Begin chest compressions without delay. Place the heel of one hand on the center of the person’s chest, specifically on the lower half of the breastbone. Put your other hand on top and interlock your fingers. Position yourself directly over the person’s chest with your arms straight.
- Compressions should be delivered at 100 to 120 per minute, with a depth of at least 2 inches, while avoiding excessive force. Push hard and fast, allowing complete chest recoil between compressions. This recoil is crucial for maintaining coronary artery perfusion pressure.
- After 30 compressions, open the airway using the head-tilt, chin-lift maneuver. Tilt the head back gently while lifting the chin. Pinch the nose shut, take a normal breath, and create a complete seal over the person’s mouth. Deliver two rescue breaths, each lasting about one second and making the chest rise visibly.
Continue this cycle of 30 compressions to 2 breaths until an automated external defibrillator arrives, emergency services take over, or the person shows signs of life.
Is CPR Always 30 Compressions to 2 Breaths?
The compression-to-ventilation ratio varies based on several factors, including the victim’s age and the number of rescuers present.
Standard Ratios for Different Scenarios
For adults, the compression-to-ventilation ratio is 30:2, meaning 30 chest compressions followed by 2 rescue breaths. This ratio applies whether you’re performing CPR alone or with another rescuer.
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For children and infants with a single rescuer, the ratio remains 30:2. However, when two trained healthcare providers are available, the ratio changes to 15:2 for children and infants, allowing for more frequent ventilation. Young patients are more vulnerable to hypoxia, making more frequent breathing necessary.
Hands-Only CPR Exception
In adult cardiac arrests, compression-only CPR is an acceptable alternative when rescue breaths cannot be performed. For adults, compression-only CPR by bystanders appears to be better than chest compressions with rescue breathing. This approach is particularly useful when a barrier device is unavailable or the rescuer is uncomfortable performing mouth-to-mouth ventilation.
However, for children, drowning victims, and drug overdose cases, conventional CPR with rescue breaths is strongly preferred since these situations typically involve respiratory causes.
Advanced Airway Modifications
When an advanced airway is in place, such as an endotracheal tube, the approach changes significantly. Continuous compressions are performed with 1 breath every 6 seconds, approximately 10 breaths per minute, without pausing compressions. This maximizes uninterrupted blood flow while maintaining oxygenation.
Performing Manual CPR: Critical Technique Details
Manual CPR effectiveness depends entirely on proper technique. Even small errors can significantly reduce blood flow to vital organs.
Hand Placement and Body Mechanics
Position is everything. Your hands must be placed on the lower half of the sternum, avoiding the tip of the breastbone, which can cause injury. Use your body weight rather than arm strength to deliver compressions. Keep your elbows locked and shoulders directly above your hands.
The compression depth must reach at least 2 inches for adults. Studies show the previously decided compression depth of 4 to 5 cm was insufficient, leading to the “push hard, push fast” emphasis. Shallow compressions fail to generate adequate blood flow to the brain and heart.
Maintaining Quality Throughout
Fatigue is the enemy of effective CPR. Rescuers should switch roles every two minutes to prevent exhaustion, which leads to decreased compression depth and rate. Even experienced providers experience significant fatigue, reducing CPR quality after just two minutes of continuous compressions.
Between compressions, allow complete chest recoil. Don’t lean on the chest. This recoil allows the heart to refill with blood, maximizing the effectiveness of the next compression.
The Correct Order for CPR: Following the Chain of Survival
Understanding the proper sequence ensures no critical steps are missed during this high-stress emergency.
The CPR Sequence
The correct order begins with scene safety assessment. Never put yourself in danger—you cannot help anyone if you become a victim too.
Next comes recognition and activation of emergency services. Check responsiveness and breathing simultaneously. This should take no more than 10 seconds. If the person is unresponsive and not breathing normally, cardiac arrest has occurred.
Begin immediate chest compressions using the CAB sequence. Compressions come before airway and breathing because they are the most critical component for survival. Research shows chest compressions are crucial for maintaining blood flow to the brain and heart during cardiac arrest.
After 30 compressions, open the airway and deliver 2 rescue breaths. Continue this 30:2 cycle without lengthy interruptions. Every second of interrupted compressions means less blood flow to the brain.
Role of AEDs in Sudden Cardiac Arrest
Automated external defibrillators are game-changers in cardiac arrest survival. Survival from cardiac arrest doubled when a bystander stepped in to apply an AED before emergency responders arrived.
AEDs should be used as soon as they become available. Modern devices are designed for anyone to use—they provide clear voice prompts and will only deliver a shock if the heart rhythm is shockable. You cannot hurt someone more by using an AED; you can only help.
Every minute that defibrillation is delayed reduces survival chances by 7-10%. This is why public access to AEDs in gyms, schools, airports, and other public spaces is so critical. Cardiac arrest victims in gyms and health clubs with an AED present have a 93% chance of survival versus just 9% when no AED is available.
When the AED arrives, turn it on immediately and follow the prompts. Continue CPR while the AED pads are being applied. The device will analyze the heart rhythm and instruct you whether a shock is needed. After any shock delivery or when the AED advises no shock, immediately resume CPR, starting with compressions.
The Role of AEDs in Sudden Cardiac Arrest Survival
The evidence supporting early defibrillation is overwhelming. A study examining 13,769 out-of-hospital cardiac arrests found that 7% of victims with no bystander CPR or defibrillation survived, compared to much higher rates when early intervention occurred.
Speed is everything with AEDs. The average emergency medical services response time is 8-12 minutes, and cardiac arrest victims have the best survival chances if they receive defibrillation within the first 5 minutes. Bystanders with AED access can deliver this life-saving shock minutes before professional help arrives.
The role of AEDs in sudden cardiac arrest cannot be overstated. They represent the single most important tool for reversing cardiac arrest after high-quality CPR. While CPR maintains minimal blood flow to vital organs, only defibrillation can restore a normal heart rhythm.
Take Action: Get Certified and Save Lives
Only 41.7% of out-of-hospital cardiac arrest patients received bystander CPR in 2024. This statistic represents thousands of preventable deaths. You can change this by getting trained and ready to act when moments matter.
Why Certification Matters
Reading about CPR provides knowledge, but hands-on practice builds the muscle memory and confidence needed during actual emergencies. Stress-free, hands-on training ensures you can perform effectively when every second counts.
For healthcare providers and first responders, maintaining current certification is essential for career requirements and optimal patient outcomes. Updated training incorporates the latest evidence-based practices from the 2025 American Heart Association Guidelines.
Your Next Steps
Don’t wait for an emergency to wish you were prepared. CPR Cincinnati, an American Heart Association training site, offers comprehensive certification courses that prepare you to save lives. Their stress-free, hands-on classes cover BLS for Healthcare Providers, ACLS, PALS, and CPR and First Aid.
Whether you need BLS certification in Kansas City for your healthcare career or want CPR certification in Kansas City to protect your family and community, expert instructors provide the training you need. All courses follow current American Heart Association guidelines, ensuring you learn the most effective techniques.
Visit CPR Kansas City today to enroll in a certification course. When cardiac arrest strikes someone you love or a stranger in public, you’ll have the skills and confidence to act decisively. Your certification could mean the difference between life and death.
Frequently Asked Questions
How long should you perform CPR before stopping?
Continue CPR until one of three things occurs: professional emergency services arrive and take over, an AED becomes available and is ready to use, or the person shows obvious signs of life such as normal breathing, movement, or consciousness. Never stop CPR simply because you’re tired—if multiple rescuers are available, switch every two minutes to maintain quality compressions. In out-of-hospital settings, bystanders should continue until emergency medical services personnel explicitly tell them to stop.
Can you perform CPR incorrectly and cause harm?
While proper technique is important for maximum effectiveness, you cannot harm a cardiac arrest victim more by performing CPR; even imperfect CPR is better than no CPR. The person is already in cardiac arrest with no circulation, so any blood flow you generate through compressions helps. The most common “mistakes” are compressions that are too shallow or too slow, which reduce effectiveness but don’t cause harm. The only way to truly harm someone is by performing CPR on a person who doesn’t need it, which is why checking for responsiveness and normal breathing is the critical first step.
What is the role of AEDs in sudden cardiac arrest for children?
AEDs can be safely used on children over one year of age. For children ages 1 to 8, pediatric pads or a pediatric dose attenuator should be used if available, as these deliver a lower energy shock appropriate for smaller bodies. If pediatric pads are unavailable, adult pads can be used—never delay defibrillation searching for pediatric equipment. For infants under one year, a manual defibrillator operated by trained healthcare providers is preferred, but if unavailable and an AED is the only option, it can be used. The role of AEDs in sudden cardiac arrest for pediatric patients follows the same principle as adults: early defibrillation dramatically improves survival when a shockable rhythm is present.
