CPR for Adults, Children, and Infants: Current AHA Protocol

The First 30 Seconds

Speed matters. Every minute without CPR reduces survival by approximately 10%.

Step 1: Confirm unresponsiveness. Tap the shoulders firmly and shout "Are you OK?" No response.

Step 2: Call 911. Or direct someone else to call and get an AED. "You — call 911. You — get the AED."

Step 3: Check for pulse (10 seconds max).

• Adult/Child: carotid pulse (side of neck, in the groove beside the windpipe)
• Infant: brachial pulse (inside of upper arm) If no pulse (or you are not certain), begin CPR.

Step 4: Check for breathing. Look for chest rise. If absent or only gasping (agonal breathing), begin CPR.

Do not check breathing by holding a mirror to the mouth or feeling for breath on your hand. These are not reliable. Look for chest rise.

Adult CPR Technique

Compression Technique

1. Position: Patient on their back on a firm surface. Do not perform CPR on a soft mattress — compressions lose depth. Move the patient to the floor.

2. Find the correct hand position: Place the heel of your hand on the lower half of the sternum — approximately in the center of the chest between the nipples. Do not press on the ribs, the tip of the sternum, or the upper abdomen.

3. Stack your hands. Place the heel of your second hand on top of the first. Interlace fingers and keep them raised off the chest.

4. Body position: Arms straight, locked at the elbows. Lean directly over the patient's chest so your shoulders are over your hands. Use body weight, not arm strength.

5. Compression: Push down 2-2.4 inches (5-6cm). You must compress this far — most bystander compressions are too shallow. Feel the sternum under your hand.

6. Full recoil: Allow the chest to fully rise between compressions. Do not lean on the chest. The heart fills with blood during recoil — no recoil means no refill.

7. Rate: 100-120 compressions per minute. This is faster than you think. Count aloud: "1-2-3-4-5-6-7-8-9-10..." and complete 30 compressions in about 18 seconds. A common mnemonic: the beat of "Stayin' Alive" by the Bee Gees is exactly 103 beats per minute.

8. Minimize interruptions. No more than 10 seconds off the chest for any reason.

Rescue Breathing (Conventional CPR)

After 30 compressions:

1. Open the airway. Head-tilt chin-lift: place one hand on the forehead, tilt back; place two fingers under the bony chin, lift. This extends the neck and opens the airway.

2. Give 2 rescue breaths. Pinch the nose closed. Create a seal over the mouth. Give a 1-second breath — enough to see the chest rise. No more. Overinflation causes air to enter the stomach.

3. If the first breath does not go in (chest does not rise), re-tilt the head and try once more, then resume compressions regardless.

4. Resume compressions immediately after 2 breaths. The pause for rescue breaths should be no more than 10 seconds.

5. Continue 30:2 ratio.

Child CPR (Age 1 Year to Puberty)

Children are not small adults. Pediatric cardiac arrest is usually caused by respiratory failure (drowning, airway obstruction, respiratory illness) rather than primary cardiac causes. Rescue breaths are more important in children than in adults for this reason.

Compressions: Use one or two hands on the lower half of the sternum. Compress to 2 inches or 1/3 of the chest's front-to-back diameter. Same rate: 100-120 per minute.

Two-rescuer ratio: 15:2 (versus 30:2 for single rescuer). When two trained rescuers are available, the more frequent rescue breathing provides additional benefit in pediatric arrest.

AED: AED use is appropriate for children. For children under 8, use pediatric electrode pads (attenuated dose) if available. If only adult pads are present, use them — the benefit outweighs the theoretical risk.

Infant CPR (Under Age 1)

Technique differs significantly for infants.

Compressions:

• Two-finger technique: Place two fingers (usually index and middle) on the center of the chest, one finger-width below the nipple line. Do not compress over the xiphoid (the small bony protrusion at the bottom of the sternum).
• Two thumb-encircling technique (preferred for two rescuers): Place both thumbs on the sternum, fingers encircling the infant's torso. Superior force and depth control compared to two-finger.
• Compress 1.5 inches or 1/3 of chest AP diameter.
• Rate: 100-120 per minute.

Rescue breathing:

• For infants, cover both the mouth and nose with your mouth to form a seal.
• Give small puffs of air — just enough to see the chest rise. Infant lungs are tiny; adult-sized breaths cause gastric inflation and lung damage.

Checking response: Tap the bottom of the foot, not the shoulder (less alarming for an infant that is not in arrest).

AED: Do not use an AED on an infant under 1 year unless that is the only available device and the alternative is no defibrillation.

AED Use

Automated External Defibrillators are designed for lay rescuers. Turn it on. Follow the voice prompts. The device makes the decisions.

What the AED does: Analyzes the heart rhythm automatically. Advises shock only for shockable rhythms (ventricular fibrillation, pulseless ventricular tachycardia). Will not shock a non-shockable rhythm.

Placement:

• One pad on the upper right chest (below the collarbone, right side)
• One pad on the lower left chest (below the armpit, left side)
• Pads should not touch each other and should not be on implanted devices (pacemakers, defibrillators)

Shock delivery: Confirm no one is touching the patient. Say "Clear!" Move back. Press the shock button.

After shock: Resume CPR immediately — do not pause to check for pulse. Give 2 minutes (5 cycles of 30:2) before the AED re-analyzes.

If no AED is available, continue CPR until:

• The patient shows signs of life (movement, breathing, purposeful responses)
• AED arrives
• Advanced medical help arrives
• You are physically unable to continue

High-Quality CPR: What It Looks Like

A trained observer watching good CPR sees:

• The chest compresses visibly with each push
• Compressions return all the way up before the next push
• Rate is rhythmic and fast (not slow, not frantic)
• Pauses between cycles are brief
• The rescuer is leaning straight over the patient, using body weight

A trained observer watching poor CPR sees:

• Shallow compressions (not enough depth)
• Leaning on the chest between compressions
• Slow rate (often 60-70 per minute feels fast, but it is not)
• Long pauses checking for pulse or adjusting position
• Tired rescuer continuing past effectiveness (rotating compressors every 2 minutes prevents this)

Rotate compressors every 2 minutes. Compression quality degrades rapidly with fatigue. If a second person is available, swap every 2 minutes when the AED re-analyzes.