Cardiopulmonary resuscitation (CPR): Procedure and Guidelines For Children and Adults

Key takeaways:

• Cardiopulmonary resuscitation (CPR) is a life-saving procedure that should be administered when a patient is unresponsive and has no breathing or is only gasping.
• For adult patients, call for emergency services immediately, but for infants and children, try 2 minutes of CPR alone and only then seek help.
• The compression depth of CPR should be 2" for adults and 1/3 of the depth of the chest for children and infants. The rate should be 100-120 compressions per minute.
• If you’re trained to give rescue breaths, do so gently and lightly to prevent too much air from entering a child or infant. Also, follow the AED’s (Automated External Defibrillator) instructions carefully to ensure you use it correctly.

Cardiopulmonary resuscitation (CPR) is a procedure used in emergencies to restore normal blood circulation and oxygen delivery to vital organs when the heart suddenly stops functioning. 

The CPR guidelines for children and adults are different because of variations in body functioning in both age groups.

For adult patients, CPR, in most cases, involves cycles of chest compressions and rescue breaths, while for children and infants, the technique requires modification. There is less emphasis on compression depth, hand placement, and breath frequency to prevent injuries.

Learning these guidelines can help people in emergencies by encouraging them to perform their best and save someone’s life in critical moments.

What is cardiopulmonary resuscitation (CPR)?

Cardiopulmonary resuscitation (CPR) is a manual emergency treatment that can be performed when a person’s heart stops, for example, in cases of heart attack, choking, drowning, or severe trauma.

CPR consists of two basic actions: chest compressions and mouth-to-mouth ventilations. It is usually done outdoors or in a non-hospital setting because additional equipment, such as bag-valve masks for ventilation, can be used instead of mouth-to-mouth in a hospital.

Chest compressions enable the heart’s pumping action by pushing blood around the body — especially to the brain, which is very sensitive to oxygen deficiency. At intervals between the chest compressions, oxygen is introduced into the blood, which is helpful to the other organs.

The basic approach to resuscitation differs slightly for adults, children, and infants due to differences in body structure. However, the main goal is maintaining blood and oxygen circulation until trained rescuers arrive.

Many people can learn CPR techniques, which help save lives in an emergency. 

Guideline and procedure for CPR on adults

The Resuscitation Council UK (RCUK) provided guidelines and procedures for CPR on adults. These include:

Hands-only CPR (compression-only CPR)

While waiting for the emergency team, chest compressions alone can effectively support circulation, especially when rescue breaths or mouth-to-mouth ventilation are challenging or unsafe.

It is useful in a sudden heart attack as a fast rate is sufficient to get blood into circulation.

Procedure for hands-only CPR:

• Step 1: Call an emergency medical service (EMS) (such as 911) or find a nearby person to make the call and find an AED (Automated External Defibrillator). An AED provides an electric shock to restart the heart during sudden cardiac arrest, which can be lifesaving while waiting for paramedics.
• Step 2: Properly position yourself by kneeling beside the person. First, wedge your palm into the middle of the chest with one hand. Then, place the other hand over the pushing hand and through the fingers.
• Step 3: Compressions. Push hard enough at a rate of a hundred and twenty times a minute, and push down on the chest for two inches deep. Let the chest rise to the maximum after each compression.
• Step 4: Stop Compressions. Perform the compressions until the rescue team arrives or the victim somewhat shows signs of consciousness.

CPR with mouth-to-mouth breaths

In certain situations, such as drowning or drug overdose, CPR with mouth-to-mouth breaths or rescue breaths may be essential. If someone is trained in CPR with rescue breaths, they should perform it; otherwise, they should proceed with compression-only CPR.

Procedure for CPR with mouth-to-mouth:

Here is a step-by-step guide to performing CPR with mouth-to-mouth breaths:

• Step 1: Note the response level by shouting while tapping or otherwise shaking the victim. If there is no response and normal breathing is absent, focus on the chest and start CPR.
• Step 2: Call emergency services. You can contact emergency services or ask someone to get help and an automated external defibrillator if one is present.
• Step 3: Place hands in position and perform 30 chest compressions, comprising 30 quick, firm presses at 100-120 compressions per minute. As in hands-on CPR, one hand must rest on the middle of the chest, with the second resting on top of the first. Push quickly and hard (2 inches deep) without taking too long to start the second push after the first.
• Step 4: Perform 2 mouth-to-mouth rescue breaths if necessary. Once the person has completed 30 compressions, the person’s head is tilted back, their chin is lifted, their nose is pinched, while their mouth is completely covered by the mouth of the rescuer. The rescuer should supply 2 breaths into the mouth, which take about 1 second each, and ensure that the victim's chest expands during the breaths.
• Step 5: Repeat the sequence of thirty chest compressions and 2 ventilations. Don’t let up until the emergency aides arrive or until the patient shows signs of consciousness.

Wearing disposable gloves during this procedure is also recommended.

Guideline and procedure for CPR on children

CPR in children differs from that in adults because of differences in body structure and function. Here are easy and clear guidelines and procedures on how to apply CPR on children aged between 1- and 8 years:

Assess the situation:

Test a child's consciousness by asking, “Are you okay?” and drawing the child’s arm slightly and calling their attention.

If the child does not respond, shout for someone to help you or get an Automated External Defibrillator (AED) if one is available.

Place the child appropriately on his/her back on a firm, flat surface without risk, if possible.

Open the locks to the windpipe:

To open the airway, slightly tilt the child’s head. Move the forehead backward with one hand while the other pushes the chin up.

Place your ear close to the child's mouth and nose and look for evidence of breathing, which should last no more than 10 seconds. Look for movement in the child’s chest, listen for the child’s breath, and feel it as it moves across your face.

Administer breaths of rescue to the child in need:

If the child is not breathing, give two rescue breaths, first close to the child's nostrils and then cover the child’s mouth entirely and blow lightly into their mouth.

Allow the patient to inhale until their chest fully expands with each breath, which takes approximately 1 second.

Make sure the chest has time to fall back down completely between each breath.

Start chest compression:

Position one or two hands (considering the child's size and the rescuer's strength) just below the nipple line in the center of the chest and compress down to about two inches (approximately one-third of the thickness of the child’s chest).

Perform 30 compressions, each comprising 100 to 120 compressions per minute.

Effective chest compressions should be fast and strong, allowing complete chest expansion between compressions.

Carry on the cycle of CPR:

30 compressions with an emphasis on mouth-to-mouth breathing.

Monitor the rhythm and sequence to create a cycle until the baby starts to breathe independently or the emergency response team volunteers arrive.

Use an AED:

If an automated external defibrillator is available, use it as early as possible.

Applying an automated external defibrillator (AED) includes powering up, following voice instructions, and attaching pads where required. If available, use pediatric pads for children between 1 and 8. If these are unavailable, use adult pads, but ensure they do not completely fit in one location.

Then, the AED is used to evaluate the heart activity, and the electric shock is applied, or CPR is performed.

Major differences between adult and pediatric CPR

The difference between adult and pediatric CPR is summarized in the table below:

Who can perform CPR?

CPR can be done by:

• Trained individuals: Any person who has attended and passed a CPR certification, including but not limited to healthcare professionals, first responders, and civilian helpers.
• Untrained bystanders: Even without formal training, members of the public and other bystanders may attempt hands-on CPR in emergencies—that is, without the use of mechanical devices, only chest compressions, and no rescue breaths.
• Healthcare professionals: Trained personnel, including paramedics, are responsible for performing advanced CPR techniques, which may include rescue breaths, airway management, and defibrillator use.

Trained or untrained people can make paramedics’ lives easier by administering manual chest compressions and calling for an ambulance.

When to perform CPR on a person

CPR should be commenced when a person:

• Is Unresponsive: They don’t respond to voice(s), call their name, or attempt to wake them.
• Is Not Breathing but Only Gasping: This is not a complete and repetitive respiration but rather irregular sounds (sounds of inhalation) that may be interpreted as three non-coordinated exhales for every inhale.
• Has No Pulse (if trained to check for one): CPR is warranted for healthcare professionals and certified lay rescuers if they cannot detect a pulse within 10 seconds.

If any of these signs are observable, commence with CPR and seek more assistance from the emergency services. CPR, if performed within the first 4 minutes of a cardiac arrest event, can increase resuscitation success by 2 to 3 times.

Points to ensure effective CPR

Here are points to keep in mind when performing CPR to ensure you are getting it right:

• Do not pause for long between the chest compressions.
• There should be no compromise in the rate and depth of compressions.
• Do not apply pressure between two compressions to allow the chest to return to its normal position.
• The hands should be placed in a suitable position to enable maximal effectiveness and prevent injury.
• Avoid hyperventilation (quick breathing usually caused by panicking or anxiety).

Wrap up

Cardiopulmonary resuscitation (CPR) is an important technique during cardiac arrest used for restoring blood flow and breathing in unresponsive individuals. For adults, ask for help at once, perform compressions at 2-inch depth and 100-120 per minute, and rescue breaths if trained professionals are available.

For children and infants, first start CPR alone, then call for help. Compressions should be about one-third of the chest depth, with gentler infant breaths. Use an AED as soon as it is available because it greatly increases the chances of survival.