CPR Guide: How to Perform CPR for All Ages
Cardiopulmonary resuscitation (CPR) is a life-saving technique used when someone’s heart stops beating or they stop breathing. According to the American Heart Association, more than 350,000 out-of-hospital cardiac arrests occur annually in the United States, and effective CPR can double or triple a victim’s chance of survival. This guide follows the latest AHA guidelines and covers the critical steps for performing CPR on adults, children, and infants.
Why Bystander CPR Matters
The Chain of Survival — early recognition, early CPR, rapid defibrillation, advanced life support, and post-arrest care — depends on bystander intervention at the first two links. The AHA reports that the average EMS response time is 7 to 14 minutes. Without CPR, brain damage begins within 4 to 6 minutes of cardiac arrest. Bystander CPR provides vital blood flow to the brain and heart until professional help arrives.
Despite this, the CDC estimates that only about 40 percent of cardiac arrest victims receive bystander CPR. Fear of doing it wrong, legal liability concerns, and lack of training are the most common barriers. Good Samaritan laws in all 50 states protect lay rescuers who act in good faith.
How to Recognize Cardiac Arrest
Before starting CPR, confirm that the person is in cardiac arrest. Check for responsiveness by tapping and shouting. Look for normal breathing for no more than 10 seconds. Agonal gasping — irregular, noisy, shallow breathing — is not normal breathing and indicates cardiac arrest. The person will be unresponsive and not breathing or only gasping.
If the person is unresponsive and not breathing normally, immediately send someone to call 911 and retrieve an AED. If you are alone, call 911 yourself and put the phone on speaker before starting CPR.
Adult CPR: Hands-Only and Full CPR
Hands-only CPR is recommended for untrained bystanders or those unwilling to give rescue breaths. The AHA advises that hands-only CPR is as effective as conventional CPR in the first few minutes of adult cardiac arrest, especially when the arrest is of cardiac origin.
To perform hands-only CPR: kneel beside the person, place the heel of one hand on the center of the chest on the lower half of the breastbone, place your other hand on top, and lock your elbows. Push hard and fast at a rate of 100 to 120 compressions per minute, at least 2 inches deep. Allow the chest to fully recoil between compressions.
Conventional CPR adds rescue breaths. After 30 compressions, open the airway using the head-tilt chin-lift method. Pinch the nose closed, seal your mouth over the victim’s mouth, and deliver two breaths lasting 1 second each. Watch for the chest to rise. Resume compressions immediately. The AHA 2020 guidelines continue to emphasize the 30:2 compression-to-ventilation ratio for single rescuers.
Child CPR (Ages 1 to Puberty)
The technique for children is similar to adult CPR but with key modifications. Use one hand for compressions if the child is small, and compress the chest about 2 inches (one-third the depth of the chest). The compression-to-ventilation ratio is 30:2 for a single rescuer and 15:2 for two rescuers.
The AHA notes that most pediatric cardiac arrests are caused by respiratory failure rather than cardiac causes, so rescue breaths are especially important in children. If you are alone and did not witness the child collapse, perform 2 minutes of CPR (about 5 cycles) before calling 911.
Infant CPR (Under 1 Year)
For infants, use two fingers placed just below the nipple line for compressions. Compress the chest one and a half inches deep (one-third the chest depth) at 100 to 120 compressions per minute. Use a 30:2 ratio when you are alone.
When giving rescue breaths to an infant, cover both the nose and mouth with your mouth. Use gentle puffs of air — just enough to make the chest rise. Do not overinflate, as infant lungs are fragile. The Mayo Clinic emphasizes that preventing overinflation reduces the risk of gastric distension and aspiration.
Using an AED
Automated external defibrillators are designed for use by untrained bystanders. Once turned on, the AED provides voice prompts. Expose the chest and ensure it is dry. Place one pad on the upper right chest and the other on the lower left side. For children under 8, use pediatric pads if available; if not, use adult pads.
The AED will analyze the heart rhythm. Ensure no one is touching the victim during analysis. If a shock is advised, the AED will charge and instruct you to press the shock button. After the shock, resume CPR immediately, starting with chest compressions. The AHA states that every minute of delay in defibrillation reduces survival chances by 7 to 10 percent.
When to Stop CPR
Continue CPR until one of the following occurs: the person shows signs of life (movement, normal breathing, coughing), an AED is ready to analyze, trained medical professionals arrive and take over, or you are physically unable to continue. Do not stop CPR to check for a pulse unless you are a trained healthcare provider. The AHA advises that lay rescuers should focus on compressions and not interrupt them unnecessarily.
Recovery Position After ROSC
If the person regains consciousness or begins breathing normally after CPR, place them in the recovery position: roll them onto their side, tilt the head back to keep the airway open, and position the top arm and leg to stabilize the body. Continue to monitor breathing until EMS arrives.
Special Populations: Pregnant Women and Obese Individuals
CPR technique must be adjusted for pregnant women. In the third trimester, the gravid uterus can compress the inferior vena cava, reducing cardiac output during compressions. Place a rolled blanket or towel under the right hip to tilt the pelvis 15 to 30 degrees to the left. Perform chest compressions slightly higher on the breastbone than usual, as the diaphragm is displaced upward. The American Heart Association emphasizes that high-quality compressions remain the priority; tilting should not interrupt compression cycles.
For obese individuals, deeper compressions may be needed to reach the heart, and it may be harder to achieve full chest recoil if excess tissue impedes the chest wall. Ensure the person is on a firm, flat surface. If necessary, kneel on the ambulance stretcher or bed to gain enough height for effective compressions. Do not allow body habitus to delay or reduce compression quality.
CPR in Public Settings and Good Samaritan Protection
Bystanders often hesitate to perform CPR in public due to fear of causing harm or legal liability. Every state in the US has Good Samaritan laws that protect lay rescuers who render emergency care in good faith, without expectation of compensation, and without gross negligence. These laws specifically cover CPR and AED use. The AHA’s Be the Beat campaign emphasizes that doing something is always better than doing nothing — even imperfect CPR provides some blood flow to the brain and heart. Protected by law and guided by training, bystanders are the most critical link in the Chain of Survival.
Frequently Asked Questions
Can I hurt someone by doing CPR? Serious injury from CPR is rare. Rib fractures occur in approximately 30 percent of cases, but a broken rib heals. Brain damage or death from lack of CPR is permanent. The AHA is clear: the risk of harm from doing CPR is far lower than the risk of doing nothing.
Do I need to give rescue breaths? For adults, hands-only CPR is effective and recommended for untrained bystanders. For children and infants, and for adults whose cardiac arrest is from drowning or drug overdose, rescue breaths are critical. If you are trained and comfortable giving breaths, use conventional CPR.
How do I know if an AED is available nearby? AEDs are commonly found in airports, schools, gyms, office buildings, shopping centers, and community centers. Many buildings display signs indicating AED locations. Apps like PulsePoint can show the nearest public AED. See our first aid kit guide for information on building a preparedness kit.
Is CPR different for drowning victims? Yes. For drowning victims, give two rescue breaths first, then begin the 30:2 compression-ventilation cycle. Drowning-related cardiac arrest is caused by hypoxia, so ventilation is a priority. Call 911 immediately and continue CPR. See our drowning rescue guide for complete water emergency protocols.
How often should I renew CPR certification? The AHA recommends renewing CPR certification every two years. Skills deteriorate over time, and guidelines are periodically updated. The 2020 AHA guidelines introduced minor changes to compression depth and the use of mobile phone technologies to alert nearby trained responders.
Conclusion
CPR is the most critical skill in the bystander’s emergency toolkit. The AHA’s Nation of Lifesavers initiative aims to double the survival rate from cardiac arrest by 2030 by training more people in CPR. You can contribute to this goal by learning CPR, keeping your certification current, and encouraging friends and family to do the same. When a person collapses in cardiac arrest, the difference between life and death is often measured in minutes — and those minutes are in your hands.