Cardiopulmonary Resuscitation (CPR) is a time-sensitive intervention that can significantly improve the outcome for someone experiencing cardiac arrest. The effectiveness of CPR relies on the quality of chest compressions, which requires precise technique to circulate blood flow to the brain and other vital organs. Correct hand placement is the most important mechanical factor, influencing both the efficacy of the compression and the safety of the individual receiving aid. Improper positioning wastes effort and increases the risk of causing serious injury.
Identifying the Correct Compression Point
Before placing the hand on the chest, accurately locate the target zone on the sternum, or breastbone. The goal is to compress the heart between the sternum and the spine, requiring force application to the strongest part of the breastbone. The correct compression point is the lower half of the sternum, located in the center of the chest. This area provides the necessary solid base for effective force transmission.
To find this spot, locate the center of the chest, roughly between the nipples. Avoid the very bottom tip of the sternum, which is a small cartilage structure called the xiphoid process. Compressing directly on the xiphoid process or too far to the side can lead to internal injuries, such as liver laceration or fractured ribs. Focusing the force on the main body of the sternum maximizes the chance of circulating blood while minimizing the risk of causing harm.
Proper Placement of the Bottom Hand
The bottom hand, placed directly onto the chest, must be positioned with only the heel of the hand making contact. The heel, or fleshy base of the palm, is the optimal area for delivering concentrated, vertical force during compressions. Place this heel directly onto the lower half of the sternum, precisely on the center point. The orientation of this hand does not affect compression quality, but it is often easier to position it so the fingers point away from the person’s head or slightly to the side.
The fingers of this bottom hand must be lifted and kept off the chest wall entirely to prevent pressure from being distributed onto the ribs. Allowing the fingers to rest on the ribs increases the likelihood of fracturing them. To ensure the fingers remain lifted, interlace them with the fingers of the second, or top, hand once it is in place. Using only the firm heel of one hand channels the mechanical force straight down onto the breastbone, where it is most effective in compressing the heart.
Completing the Compression Stance
Once the heel of the bottom hand is correctly placed on the sternum with the fingers lifted, the second hand is stacked directly on top of it. This top hand can either be interlocked with the fingers of the bottom hand or simply placed flat over the back of the bottom hand. Stacking the hands ensures that the force is delivered through both arms, providing the stability and power for deep compressions.
The final element of the stance involves proper body alignment, which determines the efficiency and sustainability of the compressions. Your shoulders must be positioned directly over your hands, and your elbows must be kept straight and locked throughout the process. This alignment allows you to use your entire upper body weight to drive the compressions, rather than relying on the smaller muscles in your arms and back.
This technique of using body weight and locked elbows allows the rescuer to achieve the recommended compression depth: at least 2 inches, but no more than 2.4 inches, for an adult. Push hard and fast, aiming for a rate of 100 to 120 compressions per minute, ensuring full chest recoil after each push to allow the heart to refill with blood. The proper stance converts your body mass into the consistent, powerful force needed to maintain circulation until professional help arrives.