CPR Techniques: The Complete Life-Saving Reference Guide

Introduction: What is CPR and Why It Matters

Cardiopulmonary Resuscitation (CPR) is an emergency life-saving procedure performed when someone’s breathing or heartbeat has stopped. Effective CPR can double or triple a person’s chance of survival following cardiac arrest. This cheatsheet provides a comprehensive overview of CPR techniques for different age groups and situations.

Why CPR Matters:

• Brain damage can begin within 4-6 minutes after cardiac arrest
• Death can occur within 8-10 minutes
• Immediate CPR can maintain vital blood flow to the brain and heart
• Survival rates decrease 7-10% for every minute without CPR
• Bystander CPR improves survival rates by 2-3 times

Core Concepts and Principles

The Chain of Survival

Universal CPR Steps (C-A-B)

1. Compressions: Push hard and fast on the center of the chest
2. Airway: Tilt the head back to open the airway
3. Breathing: Give rescue breaths

CPR Quality Factors

CPR Techniques by Age Group

Adult CPR (Age 8+ Years)

Recognition:

• Unresponsive (tap and shout)
• No normal breathing or only gasping
• No definite pulse within 10 seconds

Sequence:

1. Ensure scene safety
2. Check responsiveness by tapping and shouting
3. Call 911 (or local emergency number) and get AED if available
4. Check for no breathing or only gasping
5. Check for no pulse (within 10 seconds)
6. Begin CPR

Technique:

• Hand Position: Two hands, one on top of the other, heel of bottom hand on center of chest
• Compression Depth: 2-2.4 inches (5-6 cm)
• Compression Rate: 100-120 per minute
• Compression-to-Ventilation Ratio: 30:2 (if providing rescue breaths)
• AED Use: As soon as available, follow prompts

Child CPR (Age 1-8 Years)

Recognition:

• Unresponsive
• No normal breathing or only gasping
• No definite pulse within 10 seconds

Sequence:

1. Ensure scene safety
2. Check responsiveness
3. If alone, perform 2 minutes of CPR before calling 911
4. If someone else is present, have them call 911 while you begin CPR
5. Check for no breathing or only gasping
6. Check for no pulse (within 10 seconds)
7. Begin CPR

Technique:

• Hand Position: One or two hands (depending on child size) on lower half of sternum
• Compression Depth: At least 1/3 depth of chest (about 2 inches or 5 cm)
• Compression Rate: 100-120 per minute
• Compression-to-Ventilation Ratio: 30:2 (one rescuer), 15:2 (two healthcare providers)
• AED Use: As soon as available, use pediatric pads/system if available

Infant CPR (Under 1 Year)

Recognition:

• Unresponsive
• No normal breathing or only gasping
• No definite pulse within 10 seconds

Sequence:

1. Ensure scene safety
2. Check responsiveness
3. If alone, perform 2 minutes of CPR before calling 911
4. If someone else is present, have them call 911 while you begin CPR
5. Check for no breathing or only gasping
6. Check for no pulse (brachial artery in inner arm)
7. Begin CPR

Technique:

• Hand Position: Two fingers in the center of chest, just below nipple line, OR two thumbs with hands encircling chest
• Compression Depth: At least 1/3 depth of chest (about 1.5 inches or 4 cm)
• Compression Rate: 100-120 per minute
• Compression-to-Ventilation Ratio: 30:2 (one rescuer), 15:2 (two healthcare providers)
• AED Use: As soon as available, use pediatric pads/system if available

Hands-Only CPR vs. Conventional CPR

Step-by-Step Processes

Performing Adult CPR

1. Ensure Scene Safety

   • Check for hazards before approaching
   • Use personal protective equipment if available

2. Check Responsiveness

   • Tap shoulders and shout “Are you okay?”
   • Look for any response

3. Call for Help

   • If alone, call 911 and put phone on speaker
   • If others present, direct specific person to call 911 and get AED

4. Check Breathing

   • Look for chest rise and fall
   • Listen and feel for breathing
   • Look for normal breathing (not gasping)

5. Check Pulse

   • Place 2-3 fingers on carotid artery (side of neck)
   • Feel for 5-10 seconds
   • If no pulse or unsure, begin CPR

6. Begin Chest Compressions

   • Position hands in center of chest
   • Keep arms straight, shoulders over hands
   • Push hard (2-2.4 inches deep)
   • Allow complete chest recoil
   • Maintain rate of 100-120 compressions per minute

7. Open Airway

   • Head-tilt, chin-lift maneuver
   • Place one hand on forehead, fingers of other hand under chin
   • Tilt head back gently

8. Provide Rescue Breaths (if trained)

   • Pinch nose closed
   • Create seal with mouth or barrier device
   • Give 2 breaths (1 second each)
   • Watch for chest rise with each breath

9. Continue CPR

   • Repeat cycle of 30 compressions to 2 breaths
   • Minimize interruptions in compressions
   • Switch providers every 2 minutes if possible to prevent fatigue

10. Use AED When Available

    • Turn on AED
    • Follow voice/visual prompts
    • Attach pads to bare chest as shown in diagram
    • Ensure no one touches victim during analysis
    • If shock advised, ensure no one touches victim and press shock button
    • Resume CPR immediately after shock or if no shock advised

11. Continue Until

    • Victim shows signs of life
    • EMS arrives and takes over
    • AED provides different instructions
    • You are too exhausted to continue
    • Scene becomes unsafe

Using an AED (Automated External Defibrillator)

1. Power on the AED

   • Press the power button
   • Some AEDs turn on automatically when opened

2. Expose the Chest

   • Remove clothing covering the chest
   • If needed, quickly cut or tear clothing

3. Prepare the Chest

   • Wipe chest dry if wet
   • Shave excessive chest hair if a razor is available and pads won’t stick
   • Remove medication patches and wipe area

4. Apply the Pads

   • Peel backing from adhesive pads
   • Place one pad on upper right chest (below collarbone)
   • Place other pad on lower left ribs (below armpit)
   • Press firmly to ensure good contact
   • For children under 8, use pediatric pads/system if available

5. Clear for Analysis

   • Ensure no one is touching the victim
   • Say “CLEAR!” loudly
   • Allow AED to analyze heart rhythm

6. Deliver Shock if Advised

   • Ensure everyone is clear of victim
   • Say “CLEAR!” again
   • Press shock button if prompted
   • Some AEDs deliver shock automatically

7. Resume CPR

   • Immediately resume CPR after shock delivery
   • Start with compressions
   • Follow AED prompts for timing of next analysis

8. Continue Cycle

   • Perform 2 minutes of CPR between AED analyses
   • Allow AED to re-analyze every 2 minutes
   • Follow all AED prompts

Key Techniques and Methods

Proper Hand Positioning

Adult:

• Place heel of one hand on center of chest (between nipples)
• Place other hand on top, interlacing fingers or keeping them off chest
• Position shoulders directly above hands, arms straight

Child:

• Place heel of one hand on center of chest (between nipples)
• For smaller children, may use one hand only
• Keep arm straight, shoulder over hand

Infant:

• Two-finger technique: Place two fingers in center of chest just below nipple line
• Two-thumb technique (preferred for healthcare providers): Place both thumbs side by side in center of chest just below nipple line, with fingers encircling the chest

Effective Rescue Breathing

1. Open Airway

   • Head-tilt, chin-lift: One hand on forehead, fingers of other hand under bony part of chin
   • Tilt head back to open airway
   • For suspected spinal injury: Jaw thrust without head tilt

2. Rescue Breath Delivery

   • Pinch nose closed (adults/children)
   • Create seal around mouth with your mouth or barrier device
   • For infants: Create seal over mouth and nose
   • Give 2 breaths (1 second per breath)
   • Watch for chest rise with each breath
   • Allow for exhalation between breaths

3. Troubleshooting Failed Breaths

   • If chest doesn’t rise, reposition head
   • Check for and remove visible airway obstruction
   • Maximum 2 attempts before returning to compressions

Recovery Position

When to Use:

• Victim is unresponsive but breathing normally
• No suspected spinal injury

Technique:

1. Kneel beside the person
2. Place the arm nearest to you at a right angle to their body, elbow bent, palm up
3. Bring the far arm across the chest, and hold the back of their hand against the cheek nearest to you
4. With your other hand, grasp the far leg just above the knee and pull it up, keeping the foot on the ground
5. While holding their hand against their cheek, pull on the far leg to roll them toward you onto their side
6. Adjust the upper leg so both hip and knee are bent at right angles
7. Tilt the head back to ensure the airway remains open
8. Check regularly for normal breathing

Common Challenges and Solutions

Best Practices and Practical Tips

General CPR Best Practices

• Push Hard: Don’t be afraid of pushing too hard
• Push Fast: Maintain proper rate with mental counting or music beat (e.g., “Stayin’ Alive”)
• Minimize Interruptions: Keep pauses in chest compressions under 10 seconds
• Allow Full Chest Recoil: Completely release pressure between compressions
• Switch Rescuers: Change person doing compressions every 2 minutes to prevent fatigue
• Count Out Loud: When multiple rescuers, count compressions aloud
• Use Proper Body Mechanics: Use body weight, not arm strength; keep arms straight
• Check for Responsiveness First: Always check responsiveness before calling for help
• Ensure Scene Safety: Never put yourself in danger to perform CPR

CPR During COVID-19 and Infectious Disease Concerns

• Consider hands-only CPR to reduce transmission risk
• Cover victim’s nose and mouth with cloth/mask if available
• Use face mask or barrier device with filter for rescue breaths if performing full CPR
• Wear PPE if available (mask, gloves, eye protection)
• Properly wash hands and all surfaces after performing CPR
• Follow local health authority guidance for CPR during outbreaks

Special Situations

CPR Training and Certification

Types of CPR Training

Finding CPR Training

• American Heart Association (AHA): heart.org
• American Red Cross: redcross.org
• International organizations: Local Red Cross/Red Crescent societies, St. John Ambulance, etc.
• Local options: Fire departments, hospitals, community colleges, workplaces

Maintaining Skills

• Recertify every 2 years (typical requirement)
• Practice CPR skills regularly with training manikins
• Review CPR guidelines annually
• Consider refresher courses between certifications
• Use mobile apps for skill reminders

Resources for Further Learning

Official Guidelines and Organizations

• American Heart Association Guidelines
• International Liaison Committee on Resuscitation (ILCOR)
• European Resuscitation Council
• American Red Cross

Mobile Apps

• PocketCPR
• ZOLL PocketCPR
• CPR Tempo
• American Heart Association Pocket First Aid & CPR
• Red Cross First Aid App

Online Training Resources

• AHA CPR & First Aid Training Classes
• Red Cross Online Training
• CPR Today
• National CPR Foundation

Community Resources

• Local hospitals and healthcare systems
• Fire departments and EMS services
• Community health departments
• School systems
• Workplace safety programs