Cardiopulmonary Resuscitation (CPR) is an emergency procedure performed when the heart stops beating, using chest compressions and rescue breathing to manually maintain blood flow and oxygen to the brain and other organs. To simplify these complex, time-sensitive actions for lay rescuers and medical professionals, emergency training often relies on mnemonics or acronyms. These memory tools help ensure the correct sequence of life-saving steps is followed promptly during a crisis.
Deconstructing the Acronym ACT
The acronym “ACT” is not the globally recognized, primary sequence for CPR, which is typically taught as CAB or a variation of Check, Call, Care. Instead, “ACT” is sometimes used in specific, simplified first-aid or community training programs, or in broader emergency response frameworks. In one such context, ACT is used as an umbrella term for a citizen first-aid program focusing on three distinct, high-threat emergencies: Antidote, CPR/AED, and Tourniquet.
When encountered in the context of general first response, ACT is often interpreted as a call to action—to Assess the scene, Call for help, and Treat the patient. This interpretation serves as a general emergency framework rather than a replacement for the detailed CPR sequence. Because the acronym lacks the specific steps of modern protocols, it is not the preferred method for teaching the actual mechanics of resuscitation.
The Current Official CPR Protocol
The modern, universally accepted sequence for CPR, established by major health organizations, is the CAB protocol: Compressions, Airway, Breathing. This sequence was a significant shift from the previous ABC standard, based on the finding that starting with chest compressions immediately improves survival rates for sudden cardiac arrest in adults. The heart and brain still hold enough oxygen in the blood for a few minutes following collapse, making immediate circulation the top priority.
For adult victims, the first step is to initiate high-quality chest compressions at a rate of 100 to 120 compressions per minute. Compressions should be delivered with enough force to depress the chest at least 2 to 2.4 inches (5 to 6 centimeters). The goal is to minimize interruptions to compressions, as this manual pumping action keeps oxygenated blood flowing to the vital organs. After 30 compressions, the rescuer opens the airway and delivers two rescue breaths, creating a 30:2 ratio of compressions to ventilations.
Key Differences in Adult vs. Child CPR
The general protocol changes significantly when performing CPR on a child, typically defined as one year old up to the onset of puberty, due to fundamental differences in the causes of collapse and anatomy. While cardiac arrest in adults is most often a primary heart issue, children frequently experience it secondary to a respiratory problem, such as choking or severe asthma. Because of this, rescue breaths are considered more important in pediatric CPR and may even be the starting point if the rescuer is alone and the cause is clearly respiratory.
Pediatric Compression Depth and Technique
For a child, the compression depth is shallower, aiming for about 2 inches (5 centimeters), or approximately one-third the depth of the chest. Rescuers may use one or two hands for compressions, depending on the child’s size, to achieve the correct depth. The compression rate remains 100 to 120 per minute.
Compression-to-Ventilation Ratio
The standard compression-to-ventilation ratio for a single rescuer remains 30:2. However, when two rescuers are present, the ratio changes to 15:2. This adjustment prioritizes more frequent oxygen delivery for pediatric victims.
Infant CPR
For infants, the technique is gentler, often requiring only two fingers for compressions. The required depth is about 1.5 inches.