Cardiopulmonary resuscitation (CPR)

Start CPR as soon as possible after calling for help

CPR involves the following steps:

• Danger – check for danger, for example power lines, snakes, spiders or traffic. Do not put yourself at risk.
• Response – check if the person responds. Gently touch and talk to the person as though to wake them. If there is no response, get help.
• Send for help – ring triple zero, (000) for an ambulance.
• Airway – check airway is clear. Remove any obvious obstruction to the mouth or nose such as vomit, blood, food or loose teeth, and gently tilt head back and lift chin (except babies).
• Breathing – check if the person is breathing normally or not at all. If the person is breathing normally place them in the recovery position and wait for help. The recovery position helps to keep the unconscious person’s airway clear. By positioning the person on their side, with their arms and upper leg at a right angle to their body and the head gently tilted back and the chin lifted up, any saliva or vomit can drain out of their mouth and will help to ensure that the airway is open. If they are not breathing normally then start CPR.
• CPR – If the person is not breathing normally, start CPR. Put the heel of one hand in the centre of the chest, then put the heel of your other hand directly on top of the first hand. Keeping your arms straight, push down hard and fast 30 times (almost two compressions per second). You need to push down one third of the chest depth. When you have pushed down 30 times, take a deep breath, block the person’s nose and seal your lips around their mouth. Blow into the patient’s mouth until you see their chest rise. Repeat this twice, then start another 30 chest compressions and repeat.
• Even if you do not breathe into the person’s mouth, continue the chest compressions. Giving compressions only is better than doing nothing at all. Do not give up until help arrives.
• Defibrillate – attach an AED (automated external defibrillator) if available and follow the prompts.

How to perform CPR

The below sections provide you with the basic steps for performing CPR, and covers:

• chest compressions-only CPR
• chest compressions and rescue breaths
• using an automated external defibrillator (AED)
• detailed instructions for CPR in adults, children and babies
• duration of CPR.

Chest compressions-only CPR

If you have not been trained in CPR or are worried about giving mouth-to-mouth resuscitation to a stranger, you can do chest compression-only (or hands-only) CPR.

Chest compressions are the most important part of CPR. Start chest compressions as soon as possible after calling for help.

To carry out chest compressions on an adult:

1. Place the heel of your hand on the breastbone at the centre of the person’s chest. Place your other hand on top of your first hand and interlock your fingers.
2. Using your body weight (not just your arms), press straight down on their chest, by one-third of the chest depth.
3. Repeat this until help arrives or the person recovers.

Try to give 100 to 120 chest compressions per minute.

Chest compressions with rescue breaths

If you are on your own, then do 30 chest compressions (almost two compressions per second) followed by two rescue breaths and repeat.

To give a rescue breath:

1. Open the airway by tilting the head and lifting the chin.
2. Pinch the soft part of the nose closed with your index finger and thumb, or seal the nose with your cheek.
3. Open the patient’s mouth.
4. Take a breath and place your lips over the patient’s mouth, ensuring a good seal.
5. Blow steadily for about 1 second, watching for the chest to rise. Then listen and feel for signs that air is being expelled.
6. Take another breath and repeat.

If there is more than one rescuer available then make sure:

• one person calls triple zero (000) for an ambulance
• one person starts chest compressions immediately.

Then, one person does the compressions and the other person does the rescue breaths, continuing the cycle of 30 compressions followed by 2 rescue breaths.

It is very tiring doing CPR, so if possible swap between doing rescue breaths and compressions, so you can keep going with effective compressions.

Use of automated external defibrillator (AED)

Prompt defibrillation is an important part of the resuscitation process, along with effective CPR.

Some safety points to remember include:

• AEDs must only be used for people who are unresponsive and not breathing normally.
• CPR must be continued until the AED is turned on and pads attached.
• The pads should be placed as instructed and not touching each other.
• The rescuer should then follow the AED instructions.
• Care should be taken for all people present not to touch the person during shock delivery.
• Standard adult AEDs and pads are suitable for use in children over eight years.
• Ideally, paediatric pads and an AED with a paediatric capability should be used for children between one and eight years.
• These pads also are placed as per an adult, and the pads come with a diagram of where on the chest they should be placed.
• If the AED does not have a paediatric mode or paediatric pads, then the standard adult AED and pads can be used.
• Do not use an AED on children under one year.

Detailed instructions for CPR in adults, children and babies

Adults and children

1. Danger – check that there is no danger to you or others.
2. Response – check if the person is responsive (to your voice or touch).
3. Airway – look at the person’s mouth and nose and remove obvious obstructions such as vomit, blood, food or loose teeth. (Only put the person on their side to clear the mouth and nose if the airway is still obstructed, then put them back on their back on a firm surface to commence chest compressions.)
4. Breathing – check if the person is breathing normally (gasping is not normal breathing). If the person is breathing normally place into the recovery position and wait for help. If they are not breathing normally, start CPR.
5. Start CPR – place one hand on the centre of the person’s chest, with your other hand on top and interlock your fingers. With the heel of the bottom hand, press down by one-third of the chest depth, at a steady rate, slightly faster than one compression per second. For smaller children and toddlers use the heel of one hand only. After every 30 chest compressions, give two rescue breaths.
6. Rescue breaths – Check that the mouth and airway are clear of blood, vomit, and loose teeth or food. One hand is placed on the forehead or top of the head. The other hand is used to provide chin lift. The head (NOT the neck) is tilted backwards. It is important to avoid excessive force, in case of possible neck injury. Pinch the person’s nose. Take a breath and seal your mouth over their mouth and blow steadily and firmly into their mouth. Check that their chest rises. Perform 2 rescue breaths, lasting just over 1 second.
7. Continue with cycles of 30 chest compressions then 2 rescue breaths until the person begins to recover or emergency help arrives.
8. Defibrillate – attach an AED (automated external defibrillator) if available and follow the prompts.
9. A person may show signs of recovery by moving, breathing normally, coughing or talking.

Babies and infants under one year of age

1. Danger – check that there is no danger to you or others.
2. Response – check if the baby is responsive (to your voice or touch).
3. Airway – look at the baby’s mouth and nose and remove obvious obstructions such as vomit, blood, food or loose teeth. (Only put the baby on their side to clear the mouth and nose if the airway is still obstructed, then put them back on their back on a firm surface to commence chest compressions.)
4. Breathing – check if the baby is breathing normally (gasping is not normal breathing). If the baby is breathing normally place in the recovery position and wait for help. If they are not breathing normally then start CPR.
5. Start CPR – Compressions – place 2 fingers in the middle of the chest and press down by one-third of the depth of the chest. After 30 chest compressions at a steady rate (slightly faster than one compression per second), give 2 rescue breaths.
6. Rescue breaths – look at the baby’s mouth and nose, remove any visible obstructions, keep the baby’s head in a neutral position with no pressure by your hands or fingers across the front of the baby’s neck – do not tilt the head or lift the chin. Place your mouth over the mouth and nose of the baby and using a small breath, blow into their mouth, checking that their chest rises. Perform 2 rescue breaths.
7. Continue with cycles of 30 chest compressions then 2 rescue breaths until they begin to recover or emergency help arrives.
8. A baby may show signs of recovery by moving, breathing normally, coughing or crying.

Note: Do not use an AED on children under one year of age.

Duration of CPR

Continue CPR until the person recovers, help arrives, or you are exhausted and unable to continue.

Please note…

The information above provides guidance only, and should not be relied upon as a substitute for medical advice. We recommend you attend a first-aid training course. It pays to have first aid skills because they can’t be learned in an emergency situation.

St John Ambulance Australia offers a range of first-aid courses and can be contacted at www.stjohn.org.au. To contact St John Ambulance Australia in your local area, call 1300 360 455.

CPR training

We recommend you attend a first-aid training course. It pays to have first aid skills because they can’t be learned in an emergency situation. St John Ambulance Australia offers a range of first-aid courses and can be contacted at www.stjohn.org.au. To contact St John Ambulance Australia in your local area, call 1300 360 455.

Please note…

The information above provides guidance only, and should not be relied upon as a substitute for medical advice. We recommend you attend a first-aid training course. It pays to have first aid skills because they can’t be learned in an emergency situation.

Healthdirect Australia makes no representations or warranties as to completeness or accuracy of the information and to the extent allowable by law shall not be liable for any loss or damage arising out of the use or reliance on this information. We recommend you consult a qualified health practitioner if you have any health concerns.

Sources:

Australian Communications and Media Authority (Calling the Emergency Call Service from a mobile phone – FAQs) 

Australian Resuscitation Council (Guidelines 4, 7 and 8) 

St John’s Ambulance (Adult CPR)