Category: Health & Safety

Understanding CPR & How to Use an AED

Cardiopulmonary resuscitation, commonly called CPR, is an emergency procedure used when someone is unresponsive and not breathing normally. CPR manually pumps blood through the body so oxygen can continue reaching the brain and other vital organs until the heart can be restarted or emergency professionals take over.

An automated external defibrillator, or AED, is a portable device that checks the heart’s rhythm and delivers an electrical shock when an appropriate rhythm is detected. The shock may allow the heart to return to a more effective rhythm.

CPR and an AED work together. CPR keeps some blood moving, while an AED may correct the abnormal heart rhythm causing the cardiac arrest.

Reading about these skills is helpful, but it does not replace hands-on training. A certified CPR and AED course allows you to practice correct hand placement, compression depth, rescue breaths, and AED use with an instructor.

In an actual emergency, however, do not avoid helping because you are worried that you will not perform every step perfectly. Calling 911, beginning chest compressions, and using an AED can give someone a much better chance of survival.

What Is Cardiac Arrest?

Cardiac arrest happens when the heart suddenly stops pumping blood effectively. Within seconds, the person becomes unresponsive and stops breathing normally.

Signs of cardiac arrest include:

• Sudden collapse
• No response when the person is tapped or spoken to
• No normal breathing
• Only occasional gasping, snorting, or gurgling breaths
• No purposeful movement

Cardiac arrest is not the same as a heart attack.

A heart attack occurs when blood flow to part of the heart muscle is blocked. A person having a heart attack is often awake and breathing, although a heart attack can lead to cardiac arrest.

A person in cardiac arrest is unconscious and not breathing normally. They need CPR and an AED immediately.

The American Heart Association identifies sudden unresponsiveness and absent or abnormal breathing as the primary signs of cardiac arrest.

Why Immediate Action Matters

When the heart stops pumping, the brain and other organs no longer receive the blood and oxygen they need. Permanent injury or death can occur within minutes.

CPR does not usually restart the heart by itself. Its purpose is to keep some oxygenated blood circulating while an AED and emergency medical treatment are being arranged.

The American Heart Association reports that immediate CPR can double or triple a person’s chance of surviving cardiac arrest. Early recognition, early CPR, rapid defibrillation, emergency medical care, hospital treatment, and recovery support form what is known as the Chain of Survival. American Heart Association CPR overview

Step 1: Make Sure the Area Is Safe

Before approaching, look for dangers such as:

• Traffic
• Fire or smoke
• Electrical hazards
• Chemical fumes
• Deep or moving water
• Violence
• Falling objects
• Unstable structures

Do not enter a dangerous situation. Call 911 and explain the hazard.

If the person is in water, remove them only if you can do so safely. Do not touch someone who is still in contact with an electrical source. Disconnect the electricity first or wait for trained responders.

Step 2: Check for Responsiveness

Tap the person’s shoulders and ask loudly:

“Are you okay?”

Look for normal, purposeful movement or a verbal response.

Do not shake the person violently, slap their face, or pour water on them. If the person does not respond, call for help immediately.

For a baby, gently tap the bottom of the foot and speak loudly. Do not shake a baby.

Step 3: Call 911 and Get an AED

Call 911 or direct a specific person to call.

For example:

“You in the red shirt—call 911 and bring the AED.”

If you are alone and have a mobile phone, put it on speaker. This allows you to begin CPR while answering the dispatcher’s questions and following instructions.

Tell the dispatcher:

• Your location
• That the person is unresponsive
• Whether the person is breathing normally
• The person’s approximate age
• What happened, if known
• Whether an AED is available
• Whether drowning, choking, an overdose, or an injury may be involved

If someone else is available, send that person to find an AED while you remain with the person.

AEDs are often located in:

• Schools
• Gyms
• Airports
• Shopping centers
• Government buildings
• Community centers
• Large offices
• Sports facilities
• Houses of worship
• Apartment complexes

An AED cabinet may be marked with a heart-and-lightning-bolt symbol.

Step 4: Check for Normal Breathing

Look for chest movement and listen for breathing. Take no more than 10 seconds.

Do not mistake occasional gasps for normal breathing. A person in cardiac arrest may make irregular gasping, snorting, or gurgling sounds even though the heart is not pumping blood effectively.

If the person is unresponsive and is not breathing normally or is only gasping, begin CPR.

Members of the general public should not delay CPR while trying to find a pulse. Pulse checks can be difficult and unreliable. Lay-rescuer decisions are primarily based on responsiveness and breathing.

If the person is unconscious but breathing normally, do not perform chest compressions. Call 911, place the person in the recovery position when appropriate, and continuously monitor their breathing.

Hands-Only CPR for an Adult or Teen

Hands-Only CPR consists of chest compressions without rescue breaths. It is recommended for a bystander who sees a teenager or adult suddenly collapse.

The two basic actions are:

1. Call 911.
2. Push hard and fast in the center of the chest.

Position the person

Place the person on their back on a firm, flat surface. A soft mattress will absorb some of the force and make compressions less effective.

If the person is in a bed and cannot be moved quickly and safely, begin compressions where they are while following the dispatcher’s instructions. Do not create a long delay trying to move them.

Position your hands

• Kneel beside the person’s chest.
• Place the heel of one hand in the center of the chest, on the lower half of the breastbone.
• Place the heel of your other hand on top.
• Interlock or lift your fingers away from the ribs.
• Keep your arms straight.
• Position your shoulders directly over your hands.

Give chest compressions

• Push straight down at least 2 inches for an average adult.
• Avoid compressing deeper than approximately 2.4 inches.
• Give 100 to 120 compressions each minute.
• Allow the chest to return to its normal position after every compression.
• Keep interruptions as short as possible.

Use your upper-body weight instead of relying only on the strength of your arms.

A song with a beat of approximately 100 to 120 beats per minute may help you remember the pace, but do not delay CPR to find or play music.

The goal is consistent compressions that are deep and fast enough to move blood. According to the American Heart Association’s adult basic life-support guidance, all lay rescuers should provide chest compressions when an adult is believed to be in cardiac arrest.

Conventional CPR With Rescue Breaths

People who have been trained in conventional CPR may provide both chest compressions and rescue breaths.

For one rescuer providing adult CPR, the usual pattern is:

• 30 chest compressions
• 2 rescue breaths

How to give rescue breaths

After 30 compressions:

1. Open the airway using a head-tilt and chin-lift.
2. Pinch the person’s nose closed.
3. Make a complete seal over the person’s mouth.
4. Give one breath lasting approximately one second.
5. Watch for the chest to rise.
6. Allow the air to leave.
7. Give a second breath.
8. Immediately resume chest compressions.

Each breath should be enough to make the chest visibly rise. Blowing too hard or too quickly can force air into the stomach and increase the risk of vomiting.

If the first breath does not make the chest rise, reposition the head and try again. If the second breath still does not produce chest movement, an object may be blocking the airway. Resume compressions and look for a visible object before giving the next breaths. Never perform a blind finger sweep.

Use a CPR face shield or breathing barrier if one is immediately available. Do not allow a search for protective equipment to cause a lengthy delay.

If you are unable or unwilling to provide breaths, continue chest compressions.

When Rescue Breaths Are Especially Important

Hands-Only CPR is designed primarily for a witnessed sudden collapse in a teen or adult. CPR with breaths is especially important when cardiac arrest may have resulted from a lack of oxygen, including:

• Drowning
• Drug overdose
• Choking
• Asthma or another breathing emergency
• Cardiac arrest in a child or infant
• A person who was found already unconscious rather than seen collapsing
• A prolonged cardiac arrest

If you are trained and able, provide conventional CPR in these situations. If you cannot provide rescue breaths, chest compressions are still better than doing nothing. Call 911 and follow the dispatcher’s directions.

CPR for a Child

A child is generally someone older than one year who has not yet reached puberty.

For a child who is unresponsive and not breathing normally:

1. Call 911 and obtain an AED.
2. Place the child on a firm, flat surface.
3. Begin CPR.
4. Use the AED as soon as it is available.

Use one or two hands in the center of the chest, depending on the child’s size and your ability to reach the proper depth.

Compress the chest:

• Approximately 2 inches deep
• Or about one-third the depth of the chest
• At a rate of 100 to 120 compressions per minute

If you are trained, use cycles of 30 compressions and 2 breaths when you are the only rescuer. Two-rescuer pediatric CPR uses a different compression-to-breath ratio, so follow your training and the dispatcher’s instructions.

Because children’s cardiac arrests are often caused by breathing problems, rescue breaths are an important part of pediatric CPR.

CPR for an Infant

An infant is a baby younger than one year.

For an infant who is unresponsive and not breathing normally:

1. Call 911 and follow the dispatcher’s instructions.
2. Place the infant on their back on a firm, flat surface.
3. Begin CPR.
4. Use an AED with pediatric pads if available.

For a single rescuer, current training may teach two-finger or one-hand techniques depending on the rescuer and the infant’s size. Hands-on instruction is important because infant CPR techniques can change as professional guidelines are updated.

Compress the center of the chest:

• Approximately 1½ inches deep
• Or about one-third the depth of the chest
• At a rate of 100 to 120 compressions per minute

If trained, provide 30 compressions followed by 2 gentle breaths when you are the only rescuer. Cover the infant’s mouth and nose with your mouth when giving breaths. Each breath should be gentle and just large enough to produce visible chest rise.

Do not tilt an infant’s head as far back as an adult’s. Keep the head in a neutral or slightly extended position so the airway is not closed.

Never perform adult-strength compressions or forceful breaths on an infant.

What Is an AED?

An AED is designed to be used by members of the public. It provides visual and spoken instructions throughout the process.

The device:

1. Analyzes the heart’s electrical activity
2. Determines whether a shock is recommended
3. Charges itself when appropriate
4. Instructs the rescuer when to deliver the shock
5. Directs the rescuer to resume CPR

You do not decide whether the person needs a shock. The AED makes that determination.

If the device says, “No shock advised,” immediately resume CPR. A no-shock message does not mean the person has recovered or no longer needs help.

How to Use an AED

1. Turn on the AED

Open the device and press the power button if it does not turn on automatically.

Listen carefully and follow the prompts.

2. Expose the person’s chest

Remove clothing covering the chest. Cut clothing away with the scissors included in many AED kits if necessary.

For someone wearing a bra, remove or cut it if it interferes with pad placement. Cardiac arrest is life-threatening, and the pads must contact bare skin.

3. Prepare the chest

The skin should be reasonably dry so the pads adhere properly.

• Quickly wipe away water or heavy sweat.
• Shave only the areas needed for the pads if thick hair prevents them from sticking.
• Do not spend excessive time preparing the chest.

Many AED kits contain a towel, razor, scissors, gloves, and a breathing barrier.

4. Attach the pads

Remove the backing and place the pads on bare skin exactly as shown in the pictures.

For most adults and larger children:

• Place one pad on the upper-right side of the chest, below the collarbone.
• Place the other on the lower-left side of the chest, below the armpit.

Press the pads firmly so they adhere completely.

5. Allow the AED to analyze

Stop touching the person.

Say loudly:

“Clear! Do not touch the person!”

Look around to make sure no one is touching them while the AED analyzes the rhythm.

6. Deliver the shock if instructed

If the AED says a shock is advised:

• Make sure everyone is clear.
• Press the flashing shock button if instructed.

Some AEDs deliver the shock automatically after giving a warning.

7. Resume CPR immediately

After the shock—or after a no-shock message—resume chest compressions immediately.

Do not stop to check for a pulse unless the AED, dispatcher, or emergency responder directs you to do so. Continue following the AED prompts.

The American Red Cross recommends continuing cycles of CPR and using an AED as soon as it becomes available while keeping interruptions to chest compressions as short as possible.

Helpful Resources: Browse CPR & Emergency Response Supplies for products, equipment, services, or supplies related to this section.

Using an AED on a Child or Infant

Use pediatric AED pads and a pediatric setting for young children and infants when they are available.

If pediatric pads are unavailable, use the standard adult AED pads rather than withholding defibrillation. Follow the AED’s directions and the emergency dispatcher’s instructions.

Place the pads so they do not touch each other.

For a small child or infant, this may require:

• One pad on the center of the chest
• One pad on the center of the back

This is sometimes called front-and-back placement.

Do not cut AED pads or allow them to overlap.

Special AED Situations

Wet person or wet surface

Move the person away from standing water when it is safe. Quickly dry the chest before applying the pads.

An AED may be used on a damp surface, but no one should be in contact with pooled water surrounding the person. Do not delay CPR while completely drying the person’s entire body.

Medication patches

If a medication patch is located where an AED pad must be placed:

• Wear gloves if available.
• Remove the patch.
• Wipe the area clean.
• Place the AED pad on the dry skin.

Do not place an AED pad directly over a medication patch.

Pacemaker or implanted defibrillator

A pacemaker or implanted defibrillator may appear as a small raised area beneath the skin, usually in the upper chest.

Do not place an AED pad directly over the device. Position the pad at least an inch away when possible without delaying care.

Thick chest hair

If hair prevents the pad from adhering:

• Use the razor from the AED kit to quickly shave only the pad locations.
• If an extra set of pads is available, applying and quickly removing the first set may pull away enough hair for the second set to stick.

Do not spend a long time shaving. Continue CPR while another rescuer prepares the chest if possible.

Metal surfaces

An AED can generally be used when a person is lying on a metal surface as long as the pads are attached correctly and no one is touching the person during analysis or shock delivery. Follow the device’s instructions.

Oxygen equipment

If supplemental oxygen is flowing near the person’s chest, move the oxygen source away from the chest before delivering a shock if this can be done quickly and safely. Do not turn off medically necessary oxygen for an extended period. Follow the dispatcher’s instructions.

CPR During Pregnancy

Perform CPR on a pregnant person using the same basic adult hand position and compression rate.

Do not avoid CPR because of the pregnancy. Effective resuscitation offers the best chance of survival for both the pregnant person and the baby.

Use an AED normally. Pregnancy is not a reason to withhold defibrillation.

Tell the 911 dispatcher and responding professionals that the person is pregnant or may be pregnant.

If an Opioid Overdose Is Suspected

An opioid overdose can cause very slow breathing, absent breathing, unconsciousness, gurgling sounds, and cardiac arrest.

If the person is unresponsive and not breathing normally:

• Call 911.
• Begin CPR.
• Give naloxone if it is available.
• Use an AED.
• Continue following the dispatcher’s instructions.

Do not delay CPR or AED use while waiting to see whether naloxone works. Naloxone can reverse the effects of opioids, but it does not replace breathing support, chest compressions, or emergency care.

If the Person Vomits During CPR

If the person vomits:

1. Turn them briefly onto their side.
2. Allow the material to drain.
3. Remove only material that is clearly visible in the mouth.
4. Return the person to their back.
5. Resume CPR immediately.

Do not perform a blind finger sweep. You could push material deeper into the airway.

If You Hear Ribs Crack

Chest compressions can sometimes injure ribs or cartilage. This does not mean you should stop.

A person in cardiac arrest will not survive without blood circulation. Continue CPR with correct hand placement and depth unless the person begins breathing normally, emergency responders take over, or the dispatcher tells you to stop.

The risk of an injury from CPR is far less serious than the risk of receiving no CPR during cardiac arrest.

When to Stop CPR

Continue CPR until:

• The person begins to breathe normally or shows clear signs of life
• Emergency professionals take over
• An AED is analyzing or delivering a shock
• The area becomes unsafe
• You are physically unable to continue
• A qualified professional or emergency dispatcher directs you to stop

Occasional gasps are not a reason to stop.

If the person begins breathing normally but remains unconscious, place them in the recovery position when appropriate and continue monitoring them.

Working With Other Rescuers

CPR is physically tiring, and the quality of compressions may decline after a few minutes.

If another trained or capable person is present:

• Switch compressors approximately every two minutes
• Make the switch quickly
• Keep interruptions under 10 seconds
• Have another person prepare and operate the AED
• Have someone guide emergency responders to the location
• Ask another person to collect medication and medical information

Clear communication helps everyone work together.

Common Mistakes to Avoid

During CPR and AED use:

• Do not delay calling 911.
• Do not mistake gasping for normal breathing.
• Do not spend too long checking for breathing.
• Do not delay CPR while trying to find a pulse.
• Do not place your hands over the ribs or lower tip of the breastbone.
• Do not bend your elbows during adult compressions.
• Do not lean on the chest between compressions.
• Do not interrupt compressions more than necessary.
• Do not give breaths that are too forceful.
• Do not place AED pads over clothing.
• Do not allow AED pads to touch.
• Do not touch the person while the AED is analyzing or delivering a shock.
• Do not stop CPR because the AED says no shock is advised.
• Do not avoid using an AED because you are afraid of delivering an unnecessary shock.
• Do not assume CPR has failed because the person does not immediately wake up.

A Simple CPR and AED Checklist

If someone suddenly collapses:

1. Make sure the area is safe.
2. Tap the person and call out to them.
3. Call 911 and send someone for an AED.
4. Check for normal breathing for no more than 10 seconds.
5. If the person is not breathing normally or is only gasping, begin CPR.
6. Push hard and fast in the center of the chest.
7. Maintain a rate of 100 to 120 compressions per minute.
8. Give rescue breaths if you are trained and the situation calls for them.
9. Turn on the AED as soon as it arrives.
10. Attach the pads to the bare chest as pictured.
11. Make sure everyone stands clear during analysis and shock delivery.
12. Resume CPR immediately after the AED gives its instruction.
13. Continue until emergency professionals take over or the person begins breathing normally.

Getting CPR and AED Training

A written guide can help you understand the process, but hands-on training builds confidence and muscle memory.

Training is available through organizations such as:

• The American Heart Association
• The American Red Cross
• Hospitals and healthcare systems
• Fire departments
• Community centers
• Schools and colleges
• Workplace safety programs

Some courses include:

• Adult CPR
• Child and infant CPR
• AED use
• Choking response
• Rescue breathing
• Opioid overdose response
• Basic first aid

Certification requirements vary by employer and profession. If you need CPR certification for work, confirm that the course meets your employer’s requirements before enrolling.

Even if certification is not required, learning CPR is worthwhile. Cardiac arrest often happens at home, which means the person who needs your help may be someone you know.

Suggested Guides

• First Aid Basics: What Everyone Should Know
• What to Do When Someone Is Unconscious
• Recognizing a Heart Attack or Stroke
• What to Do When Someone Is Choking
• Responding to Serious Difficulty Breathing or an Asthma Attack
• How to Control Serious Bleeding

Important Health & Safety Notice

The information in this guide is provided for general educational purposes only. Independence Answers is not a medical provider, and this content is not a substitute for professional medical advice, diagnosis, treatment, or supervision. Always follow the instructions of your doctor, pharmacist, or other qualified healthcare professional, especially if you have a medical condition, take medication, or are unsure whether an action is safe for you.

Do not ignore or delay seeking professional care because of something you read here. If you believe someone may be experiencing a serious or life-threatening emergency, call 911 or your local emergency number immediately.