Cardiopulmonary Resuscitation (CPR) is an emergency procedure performed when a person’s heart has stopped beating effectively. This technique combines chest compressions and rescue breaths to manually maintain blood flow and oxygen delivery to the brain and vital organs until advanced medical help arrives. Immediate recognition and intervention can double or even triple a victim’s chances of survival following a cardiac arrest.
Safety and Activating Emergency Services
Before approaching a person who has collapsed, the rescuer must first assess the environment for potential hazards. Scene safety is paramount, as a dangerous situation, such as live wires or traffic, could turn a single victim into multiple casualties. Only after confirming the area is safe should the rescuer proceed.
The next immediate step is to activate the emergency response system by calling 911 or the local emergency number. If a bystander is present, direct them specifically to make the call and to retrieve an Automated External Defibrillator (AED) if one is nearby. For an unwitnessed collapse in an adult, the current medical consensus is to “Call First,” ensuring professional help is en route before starting physical assessment and CPR.
This “Call First” approach prioritizes the rapid arrival of a defibrillator, which is often the most effective treatment for sudden cardiac arrest in adults. If the collapse was witnessed, particularly if respiratory problems were a concern, or if the victim is a child, the protocol may shift.
Recognizing the Critical Signs for CPR
The need for Cardiopulmonary Resuscitation is determined by a specific combination of physical signs that confirm the person is in cardiac arrest and requires immediate intervention. The two primary indicators that should prompt a lay rescuer to begin CPR are unresponsiveness and a lack of normal breathing.
Unresponsiveness is checked by gently tapping the person and shouting loudly, such as asking, “Are you okay?” If the person does not respond by moving, speaking, or blinking, they are considered unresponsive. This lack of reaction suggests a severe compromise of brain function, often due to a lack of oxygenated blood flow.
The second sign, lack of normal breathing, includes any breathing pattern that is clearly abnormal or absent. Recognizing “agonal gasps” is necessary for bystanders. Agonal gasps are an involuntary reflex that can sound like snorting, gurgling, or labored, infrequent gasps. These gasps, which may occur only a few times per minute, are a clear sign of cardiac arrest and should not be mistaken for normal breathing.
For the untrained lay rescuer, checking for a pulse can be unreliable and waste valuable time, so the focus should remain on the two more obvious signs. If a person is unresponsive and is not breathing normally, the immediate action is to begin chest compressions. CPR should be done hard and fast at a rate of 100 to 120 compressions per minute.
Specific Considerations for Children and Infants
While the core signs of unresponsiveness and absent or abnormal breathing remain the indicators for CPR, the context of cardiac arrest differs significantly in younger individuals. Cardiac arrest in children and infants is most frequently caused by respiratory failure, such as from choking or drowning, rather than a primary sudden cardiac event common in adults. This difference in cause influences the initial response protocol.
To check for responsiveness in an infant, the rescuer should gently tap the baby’s foot instead of shaking their shoulders. Because the most likely cause of distress is a lack of oxygen, the initial steps often prioritize rescue breaths and compressions. If the rescuer is alone and the collapse was unwitnessed, the protocol is typically to provide “Care First,” meaning they should perform about two minutes of CPR before pausing to call emergency services.
This “Care First” approach, which includes five cycles of 30 compressions and two breaths, is designed to quickly deliver oxygen to the child’s system. For infants, compressions are performed using two fingers on the breastbone, just below the nipple line, to a depth of about 1.5 inches.