When to Administer CPR

When someone has a cardiac arrest, if CPR is not given, they are unlikely to survive. The British Heart Foundation (BHF) estimates that there are more than 30,000 out of hospital cardiac arrests in the UK each year. Every minute without CPR and defibrillation reduces the chances of survival by up to 10%. When a person has a cardiac arrest, every second counts.

In the UK:

• Fewer than 1 in 10 people survive an out of hospital cardiac arrest.
• Around 7-8% of people where resuscitation is attempted survive to hospital discharge.
• Only 40% of people receive bystander CPR in the UK.
• Immediate initiation of bystander CPR can double or quadruple survival rates from out of hospital cardiac arrest.
• Each minute of delay reduces the probability of survival to hospital discharge by 10%.

What is CPR?

CPR stands for cardiopulmonary resuscitation. It is a life-saving medical procedure which is given to someone who is in cardiac arrest. It helps to pump blood around their body when their heart is unable to do this. A cardiac arrest is caused by an electrical problem with the heart.

The electrical problem causes the heart to stop pumping blood around the body and to the brain. This causes the person to become unconscious and stop breathing and, in this case, without CPR the person would die within minutes.

CPR needs to be administered properly in order for it to be effective. It is a life-saving skill that can help people survive and recover. If someone is unconscious and not breathing normally you should call 999 straight away and start CPR. When calling for an ambulance the operator will be able to give instructions about how to give CPR.

The combination of techniques used in CPR includes chest compressions and rescue breathing, otherwise known as mouth to mouth resuscitation. Knowing basic first aid and CPR is important as it can save someone’s life. Although there is no guarantee that someone will survive after being given CPR, it gives them a chance of survival when otherwise there would have been no chance. In an emergency situation someone’s health can deteriorate quickly.

You should always seek medical help for any of these life-threatening signs:

• Not breathing.
• Difficulty breathing.
• Unconsciousness.
• Burns.
• Severe bleeding.
• Serious accidents or trauma.

Employers have a duty to ensure that there is appropriate and adequate first aid provision in the workplace. This means that there should be someone or several people, depending upon the size of the workplace, who are trained in first aid and available if something happens. The first-aider will be trained in CPR.

Why do we administer CPR?

CPR helps keep the blood circulating and delivers oxygen to the body until specialist treatment is available. There is usually enough oxygen within the body to keep the organs alive for a few minutes but it won’t circulate around the body unless someone does CPR.

Without CPR it only takes a few minutes for a person’s brain to become injured due to a lack of oxygen. The average person can only last for 6 minutes without oxygen before irreversible damage is done to the brain. When someone goes into cardiac arrest, they may continue to breathe for a while. If they begin gasping for breath, CPR should be started straight away.

CPR is needed when a person is:

• Unconscious.
• Not breathing normally.
• Not breathing at all.

A person in cardiac arrest may be breathing but not breathing normally, for example they may be grunting, snorting or taking gasping breaths. They still require CPR; you shouldn’t wait until they stop breathing completely to begin. If you cannot feel a pulse, you should begin CPR.

If a person needs CPR, you should start immediately, as the sooner CPR is given, the higher the chance the person has of surviving. If when performing CPR the person becomes responsive again and begins to breathe on their own, this means that CPR has been successful and you can stop.

Signs that someone is regaining consciousness can include:

• Coughing.
• Opening their eyes.
• Speaking or moving purposefully.
• Starting to breathe normally.

You can stop CPR if the person regains consciousness. If the person starts to breathe normally but they are still unconscious, place them in the recovery position and monitor their breathing until help arrives.

An automated external defibrillator (AED) is a life-saving device that is used to treat someone who is having a cardiac arrest. It works by sending a high energy electric shock or pulse to the heart of someone in cardiac arrest, in order to make the heart return to its normal pumping rhythm.

CPR should continue until an AED becomes available. Paramedics will always have one of these devices with them. A defibrillator may also be known as a defib, an AED or a PAD (Public Access Defibrillator). You don’t need to be trained to use a defibrillator, they are simple and easy to use.

There are clear instructions on how to attach the defibrillator pads. It then assesses the heart rhythm and will only instruct you to deliver a shock if it is needed. You won’t be able to deliver a shock accidently as it will only let you deliver one if it has assessed that one is needed.

Defibrillators are normally located in workplaces and public spaces like shopping centres, airports, community centres and train stations. By performing CPR and using a defibrillator, you give someone the best possible chance of survival.

How to administer CPR

The way CPR is administered will vary depending on whether the person is an adult, child or infant. However, it usually involves giving chest compressions and rescue breaths. By doing this, you are taking the role of the heart and the lungs by pumping blood and oxygen around their body.

There is a step-by-step guide available on the British Heart Foundation website about how to administer CPR. The guide has changed slightly due to the coronavirus outbreak, mainly suggesting that mouth to mouth resuscitation can be avoided if you think there is a risk of infection, with only chest compressions being given.

Anyone who is having a cardiac arrest will either not be breathing at all or will not be breathing normally; they will also be unconscious. You should check for a response from the person and if there is no response, then you should dial 999 asking for an ambulance and begin CPR until medical help arrives.

Anyone who has first aid training should also be trained in CPR. Further information about how to become a first-aider is available on our knowledge base.

When to administer CPR on an infant

If a baby is not responding to you and not breathing normally, you will need to call 999 straight away and start CPR.

If a baby under 12 months old is showing signs that they may require CPR, there are certain steps that should be followed:

• Look for the source of any danger and make sure you and the child are safe.
• Attempt to get a response from the child; this can mean saying their name loudly, gently squeezing them or tickling their feet.
• Call 999 if the child is not responding. Ask for an ambulance and do not leave the child unattended.
• Make sure the child is in a neutral position such as on their back with their neck and head in line.
• Open the child’s airway by placing one hand on their forehead and gently tilting the head back and lifting the chin. You should remove any visible obstructions from the mouth and nose such as vomit, blood, food or loose teeth.
• Place your mouth over the mouth and nose of the infant and blow steadily and firmly into their mouth, checking that their chest rises. After each breath watch for the child’s chest to fall. Give 5 initial rescue breaths.
• Place 2 fingers in the middle of their chest and push down by 4cm, which will be approximately one third of the chest diameter. The depth of the chest compressions is very important. If you cannot achieve 4cm by using 2 fingers, then you should use the heel of your hand instead.
• After 30 chest compressions at a rate of 100-120 per minute, you should give 2 rescue breaths.
• You should continue with cycles of 30 chest compressions and 2 rescue breaths until they begin to recover or emergency help arrives.

It is vital that you perform rescue breaths as cardiac arrest in a baby is likely to be caused by a respiratory problem. If you are finding it difficult to keep up with the mouth to mouth breathing, continue with the chest compressions as this can still save the baby’s life.

When to administer CPR on a child

A child may need CPR if their breathing or heartbeat has stopped. This may be because of drowning, suffocation, choking or an injury. You should carry out CPR with rescue breaths on a child as it is more likely that a child will have a problem with their breathing or airways than with their heart.

You should follow these steps when administering CPR on a child over 1 year old:

• Check the child’s airways – Nose, throat and mouth – Are clear and remove any blockages such as vomit, blood, food or loose teeth. You should do this by placing one hand on their forehead and gently tilting their head back and lifting their chin.
• Make sure the child is in a neutral position such as on their back.
• If the child is breathing normally gently roll them onto their side in the recovery position.
• If they are not breathing normally, you will need to call 999 and ask for an ambulance and begin performing CPR.
• Pinch their nose and seal their mouth with your mouth and blow steadily and firmly into their mouth, checking that their chest rises as you do this. After each breath watch for their chest to fall and signs that the breath is being expelled. If the child’s chest is not rising, check again for any blockages. When giving the rescue breaths you should ensure that no air is escaping. You should give 5 initial rescue breaths.
• Press the heel of one hand in the centre of their chest and push down 5cm; this is approximately one third of the chest diameter. The depth of the compressions are very important and you should use two hands if you cannot achieve a depth of 5cm with one hand.
• After 30 chest compressions at a rate of 100-120 per minute, you should give two breaths.
• You should continue with cycles of 30 chest compressions and 2 rescue breaths until they begin to recover or emergency help arrives.

An effective way to administer the chest compressions is to lie the child on their back and kneel beside them. Place the heel of one hand on the lower half of the child’s breastbone; this is the middle of their chest.

You should position yourself above the child’s chest. Keep your arm straight and press down on their chest to a third in depth and then release the pressure. Each one counts as one compression.

You should keep going until the child begins to recover or emergency medical help arrives. If you are finding it difficult to continue with mouth to mouth breathing, you should still continue with the chest compressions as this can still save the child’s life. Permanent brain damage or death can occur within 4 minutes of a child’s blood flow stopping, therefore CPR should begin as quickly as possible.

When to administer CPR on an adult

If the person is breathing normally, gently roll them onto their side into the recovery position. If they are not breathing or breathing abnormally then you should give them CPR. If you are trained in CPR and rescue breaths and you are confident in this then you should do both. If you are not confident then you should attempt hands-only CPR instead.

To carry out a chest compression you should:

• Make sure the person is in a neutral position such as on their back. Place the heel of your hand in the centre of the person’s chest, place your other hand on top and interlock your fingers. You should position yourself with your shoulders above your hands.
• Using the weight of your whole body and not just your hands, you should press straight down 5-6cm.
• Keep your hands on their chest but release the compression and allow the chest to return to its original position.
• You should repeat these compressions at the rate of 100-120 times a minute until medical help arrives.

If you can complete chest compressions with rescue breaths, you should follow these steps:

• Place the heel of your hand on the centre of the person’s chest and place your other hand on top, interlocking your fingers, and press down 5-6cm at a rate of 100-120 compressions per minute.
• After every 30 chest compressions that you give, you should follow this by giving 2 rescue breaths.
• To give the rescue breaths, you should tilt the person’s head and lift the chin up. Pinch the person’s nose and seal your mouth over their mouth and blow firmly for one second. You should check that their chest is rising as you blow and that no air is leaking. You should give 2 rescue breaths.
• You should continue with 30 chest compressions and 2 rescue breaths until they show signs of recovering, such as breathing normally, talking, beginning to move or coughing. If they show no signs of recovering, you should continue until emergency medical help arrives.

Before beginning CPR you should check the person’s airways to ensure there are no blockages but you shouldn’t spend too long doing this as CPR is your main priority.

If you have been the person giving CPR in an emergency situation, this can be a traumatic event for you, whether the person survives or not. It is important to look after your emotional wellbeing afterwards. The British Heart Foundation offers a support page for those who have given CPR which gives advice on coping strategies, how to look after your emotional wellbeing and what support is available for you afterwards.