Cpr
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CPR guidelines 2025 AHA cardiopulmonary resuscitation updates
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CPR steps adult 2025 chest compressions AED guidelines
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Here is a thorough overview of CPR, based on current AHA guidelines and authoritative medical references:
CPR - Cardiopulmonary Resuscitation
Adult BLS Algorithm (2020 AHA)
When to Start CPR
Start CPR when a person is:
- Unresponsive (no reaction to tapping/shouting)
- Not breathing normally (no breath or only gasping)
- No pulse felt within 10 seconds
Steps (C-A-B Sequence)
1. Scene Safety & Activation
- Ensure the scene is safe
- Check responsiveness - tap shoulder, shout "Are you OK?"
- Shout for help; call emergency services (or send someone)
- Get an AED
2. C - Chest Compressions
| Parameter | Value |
|---|---|
| Rate | 100-120 compressions/min |
| Depth (adults) | At least 2 inches (5 cm), no more than 2.4 inches (6 cm) |
| Hand position | Heel of hands on lower half of sternum, arms straight |
| Recoil | Allow full chest recoil between compressions |
| Interruptions | Minimize; keep pauses < 10 seconds |
| Rescuer rotation | Every 2-3 minutes to prevent fatigue and declining quality |
Key point: Most rescuers compress too shallowly, not too deeply. "Push hard and push fast." - Miller's Anesthesia, 10e
3. A - Airway
- Head-tilt, chin-lift maneuver to open the airway
- If trauma is suspected, use jaw-thrust instead
4. B - Breathing (Rescue Breaths)
- Give 2 breaths after every 30 compressions (30:2 ratio)
- Each breath delivered over 1 second, with visible chest rise
- Ventilation rate for intubated patients: 8-10 breaths/min
- Avoid hyperventilation - it is common, harmful, and reduces survival
5. AED
- Apply as soon as available
- If shockable rhythm (VF/pulseless VT): deliver 1 shock, resume CPR immediately for 2 minutes
- If non-shockable rhythm: resume CPR immediately for 2 minutes
Compression-Only CPR
Acceptable for:
- Untrained bystanders (easier to do, dispatcher-guided)
- Adult cardiac arrest of cardiac etiology
Rescue breaths should be added for:
- Pediatric patients
- Asphyxiation-related arrests (drowning, drug overdose)
- Prolonged resuscitation efforts
High-Quality CPR - Key Principles
| Principle | Clinical Rationale |
|---|---|
| Minimize pauses | Even short pauses cause rapid drop in coronary perfusion pressure |
| Avoid hyperventilation | Rates > 30/min compromise hemodynamics and reduce survival |
| Rotate rescuers | CPR is highly fatiguing; quality degrades with exhaustion |
| Don't stop for medications | Drugs can be given simultaneously with compressions |
| Monitor ETCO2 | Low ETCO2 (< 20 mmHg) = poor flow; sharp rise (> 25-30 mmHg) = ROSC |
| Use feedback devices | Compression depth is difficult to judge without real-time feedback |
Survival Rates
- Each minute without CPR = 10-15% decrease in survival probability
- Timely bystander CPR can double the chance of survival from out-of-hospital cardiac arrest (OHCA)
- The total number of compressions delivered is a strong predictor of return of spontaneous circulation (ROSC) and good neurological outcome
Pediatric Differences
- Compression depth: ~1.5 inches for infants (2 fingers), ~2 inches for children
- Compression-to-breath ratio: 15:2 for two healthcare providers, 30:2 for lone rescuers
- Rescue breaths are especially important (asphyxiation more common cause in children)
Sources: Roberts and Hedges' Clinical Procedures in Emergency Medicine, p. 411 | Miller's Anesthesia, 10e, p. 12190-12192 | AHA 2025 Adult BLS Guidelines
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