CPR

CPR (cardio pulmonary resuscitation)

Time is of the essence for a casualty in cardiac arrest to ensure oxygenated blood reaches the heart and brain.

Automated external defibrillators (AEDs) give casualties the best chance of surviving cardiac arrest until medial help arrives. Cardio pulmonary resuscitation can help maintain circulation until the AED arrives.

Treatment

If you witness a sudden collapse or find an unconscious casualty, you should suspect they have suffered a cardiac arrest.

Check for danger to ensure that it safe for you to approach.
Try to get a response by shaking their shoulders gently and asking loudly ‘are you alright?’
If they do not response dial 999 or 112 immediately and ask for the ambulance service.
Activate speakerphone on your mobile so you can continue talking to the emergency call hander.
Open the airway by tilting the head back and lifting the chin.
Check for normal breathing for 10 seconds by looking down the chest, feeling with your cheek and listening for breathing sounds. Gasping, noisy, irregular or panting breath sounds indicate the casualty is in cardiac arrest and are not normal signs of breathing (agonal gasps). If in doubt the emergency call handler can help you identify this.
If the casualty is breathing normally, check for any circulation problems like life-threatening bleeding and continue with a Primary Survey.
If breathing is absent or abnormal send someone immediately to get an AED. You can find your nearest publicly accessible AED at https://defibfinder.uk.
Immediately start chest compressions. Place the heel of one hand in the centre of the chest, place your second hand over the top and interlock your fingers. Keep your arms locked straight above the chest.
Give 30 compressions at a rate of 100 compressions per minute. Press down on the chest for at least 5cm, but not more than 6cm.
Give 2 rescue breaths by re-opening the airway with a head tilt, chin lift. Pinch the soft part of the nose and seal your mouth over theirs. Use a protective face shield if available.
Breath twice into the casualty gently and only enough for the chest to start to rise.
Immediately return to the chest and give another 30 compressions.
Repeat this sequence until professional help arrives. Apply the AED as soon as it is available. See the AED section for help with this.

Do not stop CPR unless you are told to by a medical professional, you become exhausted and no one can take over or the casualty shows signs of recovery after receiving a shock from an AED.

Compression only CPR

If you are unwilling or unable to perform rescue breaths, performing chest compressions is better than doing nothing at all.

If there is no response, call 999/112 and send for an AED.
Start chest compressions. Place the heel of one hand in the centre of the chest, place your second hand over the top and interlock your fingers. Keep your arms locked straight above the chest.
Compress the chest to a depth of 5-6cm for adults and one third of the chest depth for infants and children.
Continue with chest compressions until an AED is available or professional medical help arrives.

Child CPR

For children older than 1 and up to 18 years of age, there are some minor differences in the CPR sequence which make it more effective, however if these cannot be remembered the adult sequence is fine to use.

Children are at even greater risk of long-term harm from cardiac arrest than adults so if you need to leave the child to call 999/112, give 1 minute of CPR first.

Cardiac arrest in a child is usually due to a progressive reduction in oxygen in the body from another cause (such as drowning, choking or serious illness). The modification to CPR recognises this.

Check for danger to ensure that it safe for you to approach.
Try to get a response by tapping their shoulders and asking loudly ‘are you alright?’
If they do not response dial 999 or 112 immediately and ask for the ambulance service. Activate speakerphone on your mobile so you can continue talking to the emergency call hander.
If there is no sign of normal breathing, give 5 initial rescue breaths to increase oxygen levels in the body.
Place one hand in the centre of the chest and give 30 chest compressions to a depth of one third of the chest, you can swap arms to prevent fatigue. For children over 12 you may need to use 2 hands to achieve an effective compression.
Give 2 rescue breaths.
Repeat 30 compressions and 2 breaths until an AED is available or professional medical help arrives.
If you have been trained and assessed in paediatric basic life support techniques you can use a further adjustment of 15 compressions to 2 breaths.

Infant CPR

For babies under 1 year old, the sequence is similar as for older children, but the technique is different.

If you need to leave the baby to call 999/112, give 1 minute of CPR first or take the baby with you to make a call.

Try to get a response by tapping the shoulders and talking loudly to wake the baby.
If they do not response dial 999/112 immediately and ask for the ambulance service. Activate speakerphone on your mobile so you can continue talking to the emergency call hander.
Check for breathing using the look, listen and feel technique. A baby will normally be breathing much faster than an adult.
If there is no sign of normal breathing, give 5 initial rescue breaths. Gently tilt the head (be careful not to over-extend) – seal your mouth over the baby’s mouth and nose and blow gently, taking care not to over-inflate the baby’s lungs.
Start 30 chest compressions using your thumbs to compress the baby’s chest by one-third of its depth Use an encircling technique, as in the image below. Place one thumb on top of the other and compress.
Repeat 30 compressions and 2 breaths until an AED is available or professional medical help arrives.
If you have been trained and assessed in paediatric basic life support techniques you can use a further adjustment of 15 compressions to 2 breaths.