CPR

What this page can and cannot do

Teachable here, completely: what CPR is, when to start, when not to, the sequence, the numbers, how it differs by age, when to stop, and what to expect.

Not teachable here: the feel of 5 to 6 cm of compression, and the rhythm of 100 to 120 a minute sustained for twenty minutes. Every UK first aid course drills those on a manikin, because they are motor skills and reading about them does not install them. Most people who have only read about it compress far too shallowly and far too slowly.

So: book a course. British Heart Foundation, St John Ambulance and the Red Cross all run them. Many are free or a few pounds and take an afternoon. It is the single highest-value preparedness action in this entire app, it costs almost nothing, and it is the one thing here you cannot download, store or improvise.

When to start

Unresponsive and not breathing normally. That is the whole test.

1. Check for danger to yourself first. Fire, gas, electricity, traffic, water.
2. Check response. Shout and shake the shoulders gently. In a baby, tap the foot.
3. Open the airway. Head tilt, chin lift. In a baby, keep the head neutral rather than tilted back.
4. Look, listen and feel for normal breathing for no more than 10 seconds.
5. If not breathing normally, start CPR.

Ring 999 first if you are alone, on speaker, and let the call handler talk you through it. They do this constantly and they are good at it. Ask about the nearest public defibrillator.

Adults and children over puberty

• Kneel beside them, shoulders directly over your hands, arms straight, elbows locked.
• Push from your hips, using your body weight, not your arms. Arms tire in two minutes; body weight does not.
• Hard and fast. The commonest error by far is too shallow and too slow.
• Full recoil matters as much as depth. The heart refills between compressions, and leaning on the chest prevents that. Come all the way up without lifting your hands off.
• Minimise interruptions. Every pause drops the pressure you have built.
• Swap every 2 minutes if someone else is there. Quality falls off sharply with fatigue and you will not notice it happening.

Rate: roughly two compressions a second. Stayin' Alive is the traditional metronome and works. So does Nellie the Elephant.

If you will not or cannot give rescue breaths, do compression-only CPR. Continuous compressions, no pauses. It is substantially better than nothing and is the recommended approach for untrained bystanders.

Children and babies

The important difference: in children, cardiac arrest is usually caused by a breathing problem rather than a heart problem. So breaths matter more, and the sequence starts with them.

• Five rescue breaths first, before any compressions. This is the key difference from adult CPR and it reflects the usual cause.
• Blow gently. Enough to make the chest visibly rise, no more. For a baby, cover mouth and nose with your mouth and use puffs from your cheeks, not full lung breaths.
• One third of chest depth is the rule that scales. On a small child that is less force than you expect; on a large child, more.
• Do not be afraid to compress a child properly. Reluctance to push hard enough on a child is a recognised problem and it costs lives.

If you are alone with a child, give one minute of CPR first, then ring 999, then continue. That differs from the adult sequence and is deliberate.

The numbers in one place

What it is actually doing

Worth understanding, because it explains why the technique matters and why you keep going.

CPR does not restart a heart. It is a manual circulation pump, keeping oxygenated blood moving to the brain and heart muscle until something can restart the rhythm, which usually means a defibrillator.

That has two consequences:

• Quality is everything. Shallow compressions move almost no blood. This is why depth and recoil matter more than any other detail.
• A defibrillator is what actually saves the person. CPR buys the time for one to arrive. Public access defibrillators are in village halls, schools, phone boxes, supermarkets, railway stations and sports clubs across the UK. Find out today where your nearest ones are. The ambulance service will tell you the access code when you ring 999.

A defibrillator will talk you through it, will not shock a heart that should not be shocked, and can be used by anyone with no training whatsoever.

When to stop

Continue until:

• Professional help arrives and takes over.
• The person shows clear signs of life: waking, moving purposefully, opening their eyes, breathing normally. Occasional gasps are not this.
• You are physically unable to continue.

Afterwards, for you

Performing CPR on someone you love, especially unsuccessfully, is traumatic in a way people are unprepared for.

• Broken ribs are normal and are not a sign you did it wrong. They are a sign you compressed properly.
• Most CPR is unsuccessful, even done perfectly, even in hospital. That is the nature of cardiac arrest, not a verdict on you.
• You will replay it. Almost everyone does.
• Talk to someone. In normal times that means your GP. In a household on its own, it means saying it out loud to another adult rather than carrying it silently.

Do not let anyone, including yourself, treat having tried as the thing that went wrong.