CPR 101CPR Manikins

What is CPR?

CPR stands for Cardiopulmonary Resuscitation. CPR is a series of immediate actions to take when a person suffers Sudden Cardiac Arrest (SCA). During SCA the heart stops suddenly and the victim’s brain is not getting oxygen. If the flow of oxygenated blood to the brain is not restored within a few minutes the victim will die. CPR training teaches lay and medical rescuers to recognize the emergency, call 9-1-1, assess for breathing and restore the flow of oxygen to the brain with chest compressions and rescue breaths.

Why do we do CPR?

The main reason to provide CPR is to restore the flow of oxygenated blood to the brain of a victim who has suffered sudden cardiac arrest (SCA). After SCA, the victim is not breathing (or not breathing adequately) and the heart is not pumping oxygenated blood to the brain or vital organs. Clinically the victim is dead. Biologically though, the victim still has a chance at survival. After 4-6 minutes without oxygen, permanent brain damage will occur. After 10 minutes without oxygen the brain is dead, biological death has occurred. Biological death is irreversible. The reason we do CPR is to keep the brain alive after SCA by pumping blood to the brain with external chest compressions and rescue breaths.

History of CPR

The origins of CPR can be traced back almost 300 years when the Paris Academy of Sciences and the Society for Recovery of Drowned Persons in Amsterdam officially recommended mouth-to-mouth resuscitation for drowning victims. Other recommendations included warming the victim, positioning the head to let fluids drain, and manual pressure to the abdomen (along with some rectal or oral fumigation with tobacco and some bloodletting).ii,iii Other pre-CPR techniques came along from different water-based clubs around the globe with names like the “Society for Resuscitating the Drowned” and the “Society for the Recovery of Persons Apparently Drowned.”[ii] These societies were able to significantly reduce drowning deaths in their areas with rudimentary techniques. Unfortunately, not much occurred for about the next couple hundred years. In 1891 the first use of chest compressions was documented by Dr. Frederick Maass, and then in 1903 external chest compressions were used successfully by Dr. George Crile. A bit more recently though, the CPR we know today began to take shape. In the 1950’s scientific proof was provided that mouth-to-mouth breathing is sufficient to maintain oxygenation because there is enough oxygen in our exhaled breath to keep someone alive. Dr. James Elam and Dr. Peter Safar went on to invent mouth-to-mouth resuscitation. In 1957 Peter Safar published, “The ABC of Resuscitation” which is said to be the foundation for public CPR training.[iii] In 1960 CPR was formally developed. Physicians were trained with close-chest message and that became the beginnings CPR training. Other notable CPR history includes:

  • Late 19th Century, The ‘Silvester Method’ is described by Dr. H.R. Silvester where an unresponsive victim is laid on his or her back, and the arms are raised above the head for inhalation and then pressed against the chest for expiration of breaths at a rate of 16 times per minute.
  • 1911, The Holder Nielson technique was described in the first edition of the Boy Scout Handbook which was very close to the Silvester Method but performed with the victim face down.
  • 1966, The National Research Council of the National Academy of Sciences convened an ad hoc conference to establish standards for teaching and performing CPR.
  • 1981, Dispatcher CPR program was developed in King County, WA so that dispatchers could give CPR instructions over the phone. This is the standard now for all 9-1-1 call centers.
  • 1983, Development of pediatric resuscitation begins though an American Heart Association national conference.
  • 1988, First pediatric basic life support and advanced life support courses become available.
  • 1990s, Public Access Defibrillation programs are developed to provide training and resources to the public to increase the odds of survival with early use of an AED by citizen rescuers.
  • Late 1990’s to today, CPR conferences occur at an international level every five years where researches discuss the latest science. CPR techniques are updated based on the best resuscitation science with one goal in mind – increased survival of cardiac arrest.

CPR Facts and Statistics

  • There are 383,000 out-of-hospital cardiac arrests annually in the U.S.
  • 4 out of 5 cardiac arrests (88%) occur at home, so it’s likely that if you know CPR you may save the life of a loved one.
  • Less than 8% of people who suffer SCA outside a hospital will survive
  • Early and effective bystander CPR can double or triple a victim’s chance at survival
  • Only 32% of SCA victims receive bystander CPR
  • CPR compressions are the most important part of CPR. Untrained rescuers or anyone who is unwilling or unable to give rescue breaths can compress the chest hard and fast in the center of the chest (at least 2 inches) and help save an adult’s life with little to no training.
  • Ventricular fibrillation (VF) is present in almost 90% of adult cardiac arrest; the only way to stop VF is with a defibrillator.
  • The sooner an AED is used the more likely it will work. A SCA victim losses 7-10% chance at survival for every minute after SCA that an AED is not used.

What is CPR Certification?

CPR certification is when a potential rescuer takes a CPR course and passes both a written and skills test in front of a certified CPR instructor. CPR certification is catered to two types of audiences: healthcare providers/professional emergency responders and the community or workplace responder. CPR techniques for healthcare workers are slightly different than those for community rescuers. Health care providers share the tasks of rescue breathing and chest compressions; they are taught how to use a bag mask ventilation device and for medical professionals, an assessment of the victim’s pulse is required to start compressions. Community rescuers start CPR when the victim isn’t breathing, a pulse check is not taught to the lay provider and tasks such a compressions and breathing are not shared. CPR is taught by a certified instructor using lecture, demonstration and video examples to convey the necessary skills. Blended learning courses where students do the classroom portion online then meet with an instructor to practice and test are an available option to traditional classroom-based courses. Practice on a CPR manikin is required for certification. At the end of a certification course students must pass a written exam and a skills test in order to receive a certification card. CPR certification is usually valid for 2 years before it expires.

How Do I get CPR Certified?

CPR is really easy to learn. To get certified in CPR contact a national training agency to locate and schedule a class with an instructor in your area. You may need to go to the instructor’s location or if you have a group, an Instructor can come to your location. Nationally recognized training agencies who certify Instructors to teach CPR include:

  • EMS Safety Services
  • American Heart Association
  • American Red Cross
  • National Safety Council
  • Emergency Care and Safety Institute (ESCI)
  • Health and Safety Institute (HSI)

The typical CPR course is about 4 hours long and requires skills practice as well as successful written and skills testing in order to receive certification.

Take a Class

Click Here to Get Certified in AED & CPR

Where Do CPR Guidelines Come From?

Today, CPR guidelines come from a wealth of international resources. A bi-annual conference of CPR-related authorities is held to gather and review research in order to identify what works to improve cardiac arrest outcomes. Every five years guidelines are updated with the most favorable research and science is developed into new teaching materials and techniques for rescuers. The guideline changes in 2010 were based on the more CPR-related data that at any other period in history. In 1992 the International Liaison Committee on Resuscitation (ILCOR) was formed to provide a forum for communication between principal resuscitation organizations worldwide.[ii] Current members of ILCOR include:

  • American Heart Association  (AHA)
  • European Resuscitation Council  (ERC)
  • Heart & Stroke Foundation of Canada (HSFC)
  • Australian and New Zealand Committee on Resuscitation (ANZCOR)
  • Resuscitation Councils of South Africa (RSCA)
  • Inter American Heart Foundation (IAHF)
  • Resuscitation Council of Asia (RCA)

How To – The Basics of CPR:

CPR is actually pretty easy to learn and remember. It is very physical work to pump on the chest, but the hardest part is remaining calm in the face of an emergency. The basic CPR steps include:

  1. Recognize the emergency (tap and shout)
  2. Activate EMS (call 9-1-1)
  3. Check for breathing
  4. Compressions: Provide 30 compressions
  5. Airway: Open the victim’s airway
  6. Breathing: Give 2 breaths
  7. Continue till help arrives

Recognize the Emergency (Tap & Shout) A victim of SCA will suddenly collapse.  Assess the scene for safety. If it’s safe approach the victim from the side. Attempt to establish a response by tapping on the victim’s shoulder and shouting loudly, “Hey! Hey, are you okay?” It the victims is unresponsive this is an emergency. You don’t need to know if he is breathing or not, what you do know is that he won’t respond to your tap and shout (victim is unresponsive) so you need to get help right away.

Activate EMS (call 9-1-1) If there is a bystander, point at the person and say, “You, go call 9-1-1 and come right back.” If the location has an AED, then state, “You, go call 9-1-1, get the AED and come right back.” If there is more than one bystander you can split the duties – send one to call 9-1-1 and another to get the AED. If you are alone with an adult victim, you will need to go call 9-1-1, get the AED and come right back. If you are alone with a child or infant you will provide CPR for 2 minutes before leaving to call 9-1-1. During that time yell for help; if bystanders do come then send them to call 9-1-1. If you are alone after two minutes and there is no suspected injury, carry the child or infant to the phone to call 9-1-1. If injury is suspected, go get the phone, call 9-1-1 and quickly return to the child.

Check for Breathing Look at the victim’s chest for 5-10 seconds to evaluate breathing. For adults, look for normal breathing (gasping or irregular breathing is not normal); for a child look for any breathing. If there is no normal breathing for an adult or no breathing for a child or infant after 5-10 seconds then start CPR beginning with chest compressions. There is no pulse check for workplace or community rescuers. If there is no breathing, the victim needs CPR – a pulse check wastes time because it’s often inaccurate (when attempted by lay providers) and delays the start of compressions. C-A-B Sequence Rescuers use the C-A-B sequence to remember the sequence of CPR steps. C-A-B stands for: Compression, Airway and Breathing.

Compressions: Provide 30 compressions Compressions need to be hard and fast. The victim needs to be on a firm flat surface. Use the following techniques:

Category Age Range Technique Location Depth
Adult From signs of puberty and up 2 Hands Center of the chest between the nipples At least 2 inches
Child Age 1 to when signs of puberty are present 1 or 2 hands Center of the chest between the nipples About 2 inches
Infant Up to age 1 (based on size and weight) 2 fingers Center of the chest, about 1 finger-width below the nipples About 1½ inches
Chest compressions are the most important part of CPR. Most rescuers do not press hard enough. The earlier compressions are started, and the quality of compressions makes a huge impact on surviving SCA. To provide effective compression:

  • Press hard and fast
    • At a rate of at least 100 beats per minute
    • The song “Staying Alive” is 100 beats per minute
    • Ensure the victim is lying on a firm, flat surface
  • Minimize interruptions
    • It takes many consecutive compressions to achieve blood flow to the brain
    • Interruption to compression reduces blood flow
    • Take no more that 10 seconds to deliver breaths between cycles of 30 compressions
  • Ensure full recoil of the chest
    • Allow the chest to rebound fully between each compression
    • Take your full weight off the victim’s chest while keeping your hands in contact with the chest

Airway: Position the head for rescue breaths Place one hand on the forehead and 2 or 3 fingers of the other hand on the bony structure of the victim’s jaw. Quickly tilt the head and lift the chin to open the airway. A victim’s own tongue is the most common cause of airway blockage in an unresponsive victim. When a victim is unresponsive and flat on his back, the tongue falls into the back of the throat and blocks the airway. Titling the head and lifting the chin positions the tongue out of the way to allow air to flow from the reducer’s lips past the victim’s trachea and into the victim’s lungs.

Breathing: Give two rescue breaths Maintain the head tilt/chin lift position, pinch the victim’s nose and seal your mouth over the victm’s mouth. For an infant, cover the victim’s mouth and nose with your mouth (do not pinch the nose). Breathe into the victim’s mouth for about one second. Keep your eye towards the victim’s chest to watch for chest rise. Once the chest starts to rise, that’s enough air. Break the seal and repeat the process for a second breath. Do not breathe too fast, too hard or too much air into the victim. Over inflation of the chest forces air into the victim’s stomach and causes vomiting. If the victim vomits during CPR, roll them to the side, clear out the mouth, roll them back and continue CPR. Remember, it should take no more than 10 seconds to open the airway, give two breaths and resume compressions.

Repeat the C-A-B Sequence Maintain CPR for as long as possible. Continue CPR in cycles of 30 compressions and 2 breaths (30:2). Never stop CPR to recheck the victim’s breathing. Only stop if:

  • The victim begins to move
  • Help arrives and is ready to take over
  • An AED is ready to use (powered on, pads placed on the victim and prompting you to stop CPR)
  • You are exhausted and cannot continue

The Tools of CPR

EMS Safety Services offers a wide range of supplies necessary for the safe application of CPR. Visit our online store to find the items that best suit your needs:

CPR Masks & CPR Face Shields

CPR masks and CPR face shields protect rescuers from direct contact with a victim’s mouth during rescue breathing. The CPR face mask is a molded plastic mask. It typically comes in a clamshell case, requires quick assembly (snapping into the mask shape) and insertion of a one way valve or filter. The face mask covers the victim’s mouth and nose. Pinching the nose is not needed with the use of a face masks. It prevents the backflow of air or fluids into the victim’s mouth.

Bag Mask

A bag mask is a specialized device used by medical professionals to assist with rescue breathing. It consists of a non-rebreathing mask, self inflating bag and oxygen reservoir. The bag mask can be used with or without supplemental oxygen. During CPR, use of a bag mask requires special training and two rescuers; one rescuer does CPR and the other uses the bag mask to deliver rescue breaths after every 30th compression (adult CPR). To use the bag mask the rescuer has to be located at the top of the victim’s head and squeeze the bag with one hand while simultaneously using the other hand to open the airway and sealing the mask on the victim’s face  It’s not an easy skill to master. To become proficient at bag mask ventilation requires a lot of practice.

Automated External Defibrillator (AED)

An AED is a computerized device that provides a life saving shock to the heart of a sudden cardiac arrest. An AED can dramatically increase a SCA victim’s odds for survival from less than 5% to as high as 50% to 74% (depending on the study). For every minute after SCA without a shock from a defibrillator the victim looses about 7-10% chance at survival.  The sooner an AED is used the more likely it will work. AEDs are easy to use. Press the power button and follow the verbal prompts:

  • Bare the victim’s chest
  • Apply sticky pads (electrodes) that come with the AED to the victim’s bare chest. Pads have simple diagrams for placement.
  • Press the shock button when prompted and after you’ve checked to see that no one is touching the victim
  • Resume CPR after the shock

Remember that if an AED is not present, the sooner 9-1-1 is called the earlier professional rescuers will arrive with a defibrillator of their own.

Personal Protective Equipment (PPE)

PPE is used by community, workplace and professional rescuers to protect against exposure to a victim’s blood or body fluids. During an emergency, rescuers may be exposed to blood or body fluid. If the victim has a bloodborne pathogen (disease causing microorganism such as HIV, Hepatitis B, Hepatitis C) there is a risk that coming into contact with their blood (or body fluid contaminated with blood) may cause a transmission of the disease from the victim to the rescuer. PPE reduces the possibility of coming into contact with blood or body fluid, thereby reducing the risk of exposure. PPE for CPR includes:

  • Goggles
  • CPR barrier devices
  • Gloves

It’s important to note that there are no documented cases of HIV transmission during CPR or CPR practice.[iii]

[i] World Wide Web; American Heart Association Website, “CPR & Sudden Cardiac Arrest (SCA) Fact Sheet; http://www.heart.org/HEARTORG/CPRAndECC/WhatisCPR/CPRFactsandStats/CPR-Statistics_UCM_307542_Article.jsp; accessed 03-13-2013
[ii] World Wide Web, Internationa Liasian Committee On Resuscitation website; http://www.ilcor.org/en/about-ilcor/about-ilcor/; accessed 03-15-13