Could you save a life? The essential CPR guide for life or death situations

Every year, 30,000 people in the UK will suddenly collapse having suffered cardiac arrest. Their hearts will either have stopped beating completely, or be beating somewhat erratically. Throughout my career as an intensive care doctor I’ve cared for hundreds of patients who’ve been admitted after cardiac arrest and one of the first things I establish is whether the patient has received CPR – and if so, for how long – as this makes a real difference.

One in 10 people who receive CPR survive, and out of those survivors half have what we call a “good neurological outcome”; they’ll be back at work living normally with their loved ones, which is amazing.

But often bystanders are scared, fearing they’ll get something wrong or cause more harm. But if someone is dead, then really what harm can you do? 

The chances of surviving are doubled by prompt CPR and defibrillation, and because around 80 per cent of cardiac arrests happen in the home or the workplace, there often is someone close by who might be able to help. It’s not complicated, you don’t need to be a medic, and I’m proud to say that my daughters, aged 14 and 11, learnt how to do CPR at school because in Wales it’s part of the curriculum. 

It’s really one of the most important things you can do. 

What is cardiopulmonary resuscitation (CPR)?

CPR has been around in some form for many years. In Victorian times, air pumps along the River Thames were sometimes used to pump air into someone’s back passage if they had collapsed unconscious, hence the term “blowing smoke up their a--” was coined. In a Sherlock Holmes book there’s a description of Dr Watson saving a life by moving a patient’s arms up and down multiple times.

But it’s really only since the 1960s when chest compressions and giving the “kiss of life” (mouth-to-mouth breathing) came into common practice.

The emphasis now is on chest compressions

There are two parts to formal resuscitation. Firstly, the cardiac part – trying to get blood to flow to the most important organ, the brain – and that’s predominantly through chest compressions. Whereas the pulmonary part – trying to add oxygen to the blood through the lungs – has taken more of a back seat. Previously, there was more emphasis on breathing into the mouth; now the emphasis is more on chest compressions, which requires less skill and generally people are more comfortable with the idea of pressing rather than breathing in somebody’s mouth. It’s still very effective.

CPR step-by-step

Call for help

If someone has collapsed and seems unresponsive, the very first thing to do is call for help; ideally you need back up.

Try to rouse them

Gently shake them by the shoulder and call their name, you need to check for signs of consciousness, in case they’re just heavily sedated for some reason. 

Look and listen

Check for signs of breathing – is the chest rising up and down at a relatively normal frequency, or has breathing become shallow, irregular or stopped? Any of these last three mean you’re dealing with an emergency. 

Call 999

Put your phone on speaker. The call handler will know if there is an AED (automated external defibrillator) nearby. If there is, send someone to collect it while you stay with the patient. The call handler can also offer clear instructions on using one, as well as how to deliver chest compressions. 

Prepare to pump

Putting one hand on top of the other, interlock your fingers to make a solid base. Then place the heel of your hands in the middle of the chest, where the breastbone is. Then start pressing – firmly – about twice every second. In my book, Critical, I suggest in time to the Bee Gees’ tune Stayin’ Alive which I thought was apt, but being slightly slower or faster is still better than nothing – and could save a life. 

Don’t stop 

You do need to press hard. Generally people push too gently. But truthfully, successful CPR can result in injuries, including rib fractures, but this doesn’t mean you are doing it wrong. Administering two hard pumps a second is tiring (in hospitals we sometimes use mechanical devices for this reason), so ideally rotate the job with others until there is a sign of life or a paramedic or a defibrillator arrives. Crucially, don’t stop.

How long to carry on  

There isn’t one easy answer. There are two phases: “no flow time” (the period between when your heart stops and when CPR starts, when there’s no blood flow into the brain), and “low flow time” (from when CPR begins until the heart restarts). 

When a natural pulse comes back it’s called “return of spontaneous circulation”. Survival rates go down the longer that takes, but in stressful circumstances it’s very hard to judge timings, seconds feel like minutes and minutes like hours. 

Don’t worry about mouth-to-mouth

Unless you have been on an advanced skills course, the “kiss of life” is no longer officially recommended for adults. The vast majority of cardiac arrests occur in adults aged 15-64, and are heart-related, so compression-only is the standard advice. 

As told to Susanna Galton

CPR for babies and children

“Cardiac arrest in babies and children is not common,” says James Cant, the CEO of Resuscitation Council UK. “However it can happen, for example through drowning or swallowing a small item, like a button battery. So, it’s still crucial for parents, caregivers and anyone who interacts with children to know what to do in an emergency and help save a child’s life.”

Check for danger, then immediately follow these steps to give a child (aged 1-18) CPR.

Shout for help 

Call their name and tap them on their shoulders to see if they respond. If there’s no response, check for breathing. 

Look and listen for signs of normal breathing 

Open the child’s airway by lifting the chin with two fingers and tilting the head back so it’s in the “sniffing” position. Look for the rise and fall of their chest, and listen for breathing by putting your ear close to their mouth. 

If they’re not breathing, or not breathing normally, call 999 

Put the phone on loudspeaker and tell them you are with a child who is not breathing or not breathing normally. The ambulance call handler will tell you what to do.

Give five rescue breaths 

Pinch their nose and cover their mouth with your mouth to create a seal. Blow into their mouth and nose for one second, just enough to see their chest rise, then release and watch their chest fall. Repeat this five times. 

Start one-handed chest compressions 

Place the heel of your hand in the centre of the chest. Lift your fingers to ensure pressure is not applied over the ribs. Push down about a third of the depth of the chest (5cm), then release. Repeat the one-handed compressions 30 times, twice per second. (Use two hands for bigger children.) After 30 compressions, give two breaths. Continue with 30 compressions and two breaths. 

Continue CPR  

Continue giving the child CPR until the paramedic arrives and tells you what to do, or the child shows signs of life. 

CPR for babies aged 0-12 months

Shout for help 

As with adults this is the first thing to do. Call the baby’s name and gently tap the bottom of their feet to see if they respond. If there’s no response, check for breathing. 

Look and listen for signs of normal breathing  

Open the baby’s airway by lifting the chin with two fingers and tilting the head back so that it’s in a neutral position (not too close to the chest, and not too arched). Look for the rise and fall of their chest, and listen for breathing by putting your ear close to the baby’s mouth. 

If they’re not breathing, or not breathing normally, call 999 

Put the phone on loudspeaker and tell them you are with a baby who is not breathing or not breathing normally. The ambulance call handler will tell you what to do. 

Give five rescue breaths 

Cover the baby’s mouth and nose with your mouth to create a seal. Blow into their mouth and nose for one second, just enough to see their chest rise, then release and watch their chest fall. Repeat this five times.

Start two-finger chest compressions 

Place the tips of two fingers in the centre of the chest. Push down about a third of the depth of the chest (4cm), then release. Repeat the two-finger chest compressions 30 times, twice per second. After 30 compressions, give two breaths. Continue with 30 compressions and two breaths. The ambulance caller will help you. 

Continue CPR 

Until the paramedic arrives or the baby shows signs of life. 

Request a free copy of the baby and child CPR book Aaron’s Heart at: resus.org.uk/baby-cpr