Key Takeaways
- High-quality CPR requires a compression rate of 100-120 per minute, a depth of 2 to 2.4 inches (5-6 cm) for adults, and full chest recoil between compressions
- The compression-to-ventilation ratio is 30:2 for adults (1 or 2 rescuers) and children/infants with 1 rescuer; 15:2 for 2-rescuer child and infant CPR
- Interruptions in chest compressions should be minimized to less than 10 seconds for any reason, including rhythm checks and defibrillation
- AED pads should be placed in the anterior-lateral position: one pad on the upper right chest below the clavicle, one on the left side below the armpit
- For children under 8 years or under 55 pounds, use pediatric pads or a dose attenuator if available; if not available, use adult pads
- Before using an AED, ensure the patient is not in water, remove medication patches from the chest, and be aware of implanted devices such as pacemakers
- Hands-only CPR (compressions without ventilations) is recommended for untrained bystanders witnessing a sudden cardiac arrest in adults
CPR & AED Use
Cardiopulmonary resuscitation and early defibrillation are the most critical interventions for a patient in cardiac arrest. The quality of CPR directly impacts patient survival.
High-Quality CPR Components
The American Heart Association emphasizes these key components of high-quality CPR:
- Push hard - Adequate compression depth
- Push fast - Adequate compression rate (100-120/min)
- Allow complete chest recoil - Do not lean on the chest between compressions
- Minimize interruptions - Keep pauses to less than 10 seconds
- Avoid excessive ventilation - Do not over-ventilate the patient
CPR Specifications by Age Group
| Specification | Adult (puberty+) | Child (1 yr to puberty) | Infant (<1 year) |
|---|---|---|---|
| Compression depth | At least 2 inches (5 cm), no more than 2.4 inches (6 cm) | About 2 inches (5 cm), or 1/3 AP diameter | About 1.5 inches (4 cm), or 1/3 AP diameter |
| Compression rate | 100-120/min | 100-120/min | 100-120/min |
| Compression method | Heel of 2 hands on lower half of sternum | Heel of 1 or 2 hands on lower half of sternum | Heel of 1 hand on lower half of sternum (1 rescuer) or 2 thumb-encircling hands (2 rescuers) |
| Ratio (1 rescuer) | 30:2 | 30:2 | 30:2 |
| Ratio (2 rescuers) | 30:2 | 15:2 | 15:2 |
| Ventilation duration | 1 second per breath | 1 second per breath | 1 second per breath |
Hand Placement and Technique
Adults and Children:
- Place the heel of one hand on the center of the chest on the lower half of the sternum
- Place the other hand on top, interlocking fingers
- Keep arms straight, shoulders directly over hands
- Compress straight down
Infants (1 rescuer — 2025 AHA Update):
- Use the heel of one hand on the lower half of the sternum (just below the nipple line)
- The two-finger technique has been replaced per the 2025 AHA Guidelines Update
- Support the infant on a firm surface
- Compress to a depth of about 1.5 inches (1/3 AP diameter)
Infants (2 rescuers):
- Use the two thumb-encircling hands technique
- Place both thumbs side by side on the lower half of the sternum
- Encircle the infant's chest with both hands
- This technique generates better perfusion pressure and remains the preferred 2-rescuer method
Compression-to-Ventilation Ratios
- 30:2 = Universal ratio for single rescuer (all ages) AND 2-rescuer adult CPR
- 15:2 = 2-rescuer CPR for children and infants (because pediatric arrest is more often respiratory in origin)
- With an advanced airway in place = Continuous compressions at 100-120/min with 1 breath every 6 seconds (10 breaths/min), no pausing
Full Chest Recoil
- Allow the chest to fully return to its normal position after each compression
- Do not lean on the chest between compressions
- Leaning reduces venous return and decreases coronary perfusion
- Rotate compressors every 2 minutes (or every 5 cycles of 30:2) to prevent fatigue and maintain quality
Minimizing Interruptions
- Interruptions in compressions reduce coronary perfusion pressure
- Limit interruptions to less than 10 seconds (for pulse checks, defibrillation, airway management)
- Pre-charge the AED during compressions to minimize pause time
- Have the next compressor ready to switch immediately
AED (Automated External Defibrillator) Use
The AED is used to analyze the heart rhythm and deliver a shock if a shockable rhythm is detected.
Shockable rhythms:
- Ventricular fibrillation (V-fib) - Chaotic, disorganized electrical activity
- Pulseless ventricular tachycardia (V-tach) - Rapid organized rhythm without a pulse
Non-shockable rhythms:
- Asystole - No electrical activity ("flatline")
- Pulseless electrical activity (PEA) - Organized rhythm on monitor but no pulse
AED Pad Placement
Standard anterior-lateral placement:
- Right pad: Upper right chest, below the clavicle, to the right of the sternum
- Left pad: Left side of the chest, below the armpit (left mid-axillary line)
Pediatric considerations:
- Children under 8 years / under 55 lbs: Use pediatric pads or dose attenuator if available
- If pediatric pads are not available, use adult pads
- For infants/small children: if pads risk touching, use anterior-posterior placement (one on chest, one on back)
AED Special Considerations
| Situation | Action |
|---|---|
| Patient is wet | Quickly dry the chest before applying pads |
| Excessive chest hair | Quickly shave the area or press pad firmly and rip off, then apply new pad |
| Medication patch on chest | Remove the patch with gloved hand, wipe the area, then apply pad |
| Implanted pacemaker/defibrillator | Place pad at least 1 inch away from the device (visible bump under skin) |
| Pregnant patient | CPR and AED use are indicated; perform standard procedures |
Hands-Only CPR
The AHA recommends hands-only CPR (compressions without rescue breaths) for:
- Untrained bystanders witnessing sudden cardiac arrest in adults
- Trained bystanders who are unwilling or unable to provide ventilations
Push hard and fast in the center of the chest at a rate of 100-120 compressions per minute until EMS arrives or an AED is available.
What is the correct compression depth for an adult patient in cardiac arrest?
What is the compression-to-ventilation ratio for 2-rescuer CPR on a 5-year-old child?
You are about to use an AED on a patient and notice a medication patch on the chest where a pad needs to be placed. What should you do?
How often should rescuers switch compressor roles during CPR?
Which of the following is a shockable cardiac rhythm that an AED can treat?
What is the recommended compression technique for a single rescuer performing CPR on an infant?
Chest compressions should be performed at a rate of - per minute for all age groups.
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