CPR Guidelines: Latest Procedures and Techniques for Cardiopulmonary Resuscitation

Last updated:
May 30, 2023

CPR is a critical technique used to sustain vital functions and provide oxygen to the brain and other organs until professional medical help arrives. Over the years, CPR guidelines have evolved and been refined based on advancements in medical science and research. Staying up-to-date with the latest CPR guidelines is essential for both healthcare professionals and individuals who want to be prepared to respond in emergency situations.

In this comprehensive guide, we will explore the latest CPR guidelines, techniques, and protocols recommended by renowned organizations such as the American Heart Association (AHA) and the American Red Cross (ARC).


What Is CPR?

CPR, which stands for Cardiopulmonary Resuscitation, is an essential life-saving technique used in emergency situations to revive individuals experiencing cardiac arrest or respiratory failure. It involves a combination of chest compressions and rescue breaths to maintain blood circulation and oxygenation until professional medical help arrives.

The primary goal of CPR is to ensure that oxygen-rich blood reaches vital organs, especially the brain, during a critical moment when the heart or breathing has stopped.CPR is crucial because it buys valuable time for the individual in distress. It keeps blood flowing, preventing brain damage and increasing the chances of successful resuscitation.


Why Is Following The CPR Guidelines So Important During a Cardiac Emergency?

Following the CPR guidelines during a cardiac emergency is vital because it ensures the most effective and standardized approach to resuscitation. The CPR guidelines are based on extensive research, scientific evidence, and expert consensus, aiming to optimize the chances of successful resuscitation and improve survival outcomes.

By adhering to the CPR guidelines, responders can provide consistent and high-quality care, regardless of their level of training or experience. The guidelines outline specific techniques, ratios, and sequences for chest compressions, rescue breaths, and other interventions, ensuring a systematic and coordinated approach to resuscitation efforts.

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Cardiac Arrest

By Following the CPR Guidelines, How Much Can Survival Rates Improve After a Cardiac Arrest?

Following the CPR Guidelines can significantly improve survival rates after a cardiac arrest. Bystander CPR plays a crucial role in increasing the chances of survival for cardiac arrest victims, as it helps maintain blood circulation and oxygenation until professional medical help arrives.

Statistics show that immediate bystander CPR can more than double or even triple the likelihood of survival. According to the American Heart Association (AHA), in cases where a bystander performs CPR, the survival rates for out-of-hospital cardiac arrests can increase by 2 to 3 times. Similarly, the British Heart Foundation reports that early CPR can increase survival rates by up to 2.5 times.

Prompt initiation of CPR, along with early defibrillation using an automated external defibrillator (AED), is critical for achieving the best outcomes. Every minute without CPR and defibrillation reduces the chances of survival by around 7-10%.


Latest CPR Guidelines

The latest CPR guidelines were released by the American Heart Association (AHA) and the International Liaison Committee on Resuscitation (ILCOR). These guidelines provide updated recommendations for performing cardiopulmonary resuscitation (CPR) and managing cardiac arrest cases. Some key highlights from the CPR guidelines include:

  1. Compression-Only CPR: For adults who suffer a sudden cardiac arrest in an out-of-hospital setting, bystanders are encouraged to perform compression-only CPR (hands-only CPR) without rescue breaths. This simplifies the technique and promotes early initiation of compressions, which are crucial for maintaining blood circulation.
  2. CPR Compression Depth: The recommended compression depth for adults and adolescents is at least 2-2.4 inches (5-6centimeters), while for infants and children, it is approximately 1.5 inches (4 centimeters). Adequate compression depth ensures effective chest compressions and blood flow.
  3. CPR Compression Rate: The guideline emphasizes a compression rate of 100 to 120 compressions per minute for all age groups, including adults, children, and infants. Maintaining the appropriate compression rate helps optimize blood flow during CPR.
  4. Use of Automated External Defibrillators (AEDs): AEDs play a critical role in the management of sudden cardiac arrest. The guidelines emphasize early access and use of AEDs in appropriate cases. AEDs are user-friendly devices that can analyze the heart rhythm and deliver electric shocks if necessary to restore normal cardiac activity.

The most recent CPR guidelines serve as the gold standard for performing CPR and are essential in ensuring effective and standardized CPR practices. These guidelines are developed and regularly updated by leading organizations such as the American Heart Association (AHA) and the International Liaison Committee on Resuscitation (ILCOR).


How Do the New CPR Guidelines Differ From Previous Guidelines?

The latest CPR guidelines, such as those released in 2020, may differ from previous guidelines in several key areas.

  • Emphasis on compression-only CPR for adults in out-of-hospital settings simplifies the technique and encourages bystanders to immediately initiate chest compressions without rescue breaths.
  • The recommended compression depth has also been updated, focusing on achieving adequate depth without specifying a specific minimum value.
  • The compression rate, however, remains consistent at 100 to 120 compressions per minute for all age groups.
  • Advancements in technology are being integrated into the guidelines, with the use of automated external defibrillators (AEDs) and mobile applications to aid in CPR delivery and decision-making.


Among the Changes In The Latest CPR Guidelines, Which Ones Are Considered The Most Significant?

Among the changes in the latest CPR guidelines, one significant change is the increased emphasis on compression-only CPR for adults in out-of-hospital settings. This change acknowledges the evidence that high-quality chest compressions alone can be effective in providing circulation and oxygenation during the early stages of cardiac arrest. By focusing on compressions rather than interrupting rescue breaths, bystanders are more likely to initiate CPR immediately, increasing the chances of survival.


Adult CPR Guidelines

Over the years, the guidelines for Adult CPR have undergone significant changes, driven by advancements in resuscitation science and research. These changes aim to improve the quality and effectiveness of CPR, ultimately enhancing survival rates for individuals experiencing cardiac arrest. The updates reflect a better understanding of optimal techniques and the incorporation of new technologies to support rescuers.


Compression-Only CPR

One substantial change in the CPR guidelines is the increased emphasis on compression-only CPR for bystander response in out-of-hospital cardiac arrests. This approach simplifies CPR by focusing solely on chest compressions, eliminating the need for rescue breaths. Compression-only CPR has been found to be equally effective in the early stages of cardiac arrest, empowering bystanders to take prompt action and initiate life-saving measures.


Compression Depth and Rate

The recommended compression depth and rate have also evolved to optimize blood flow during CPR. The current guidelines stress the importance of delivering chest compressions with a depth of at least 2 inches (5 centimeters) and up to 2.4 inches (6 centimeters). This ensures adequate circulation of oxygenated blood to vital organs. Additionally, the recommended compression rate is now at least 100 to 120 compressions per minute, providing an optimal balance between chest recoil and blood flow.


Simplified CPR Algorithm

To enhance the accessibility and ease of performing CPR, the guidelines have introduced a simplified CPR algorithm. This streamlined approach focuses on the essential steps of recognizing cardiac arrest, activating emergency services, initiating chest compressions, and utilizing an automated external defibrillator (AED) as soon as available. The simplified algorithm promotes a quick response and minimizes potential delays in life-saving interventions.


Integration Of AEDs

The CPR guidelines emphasize the importance of early defibrillation in improving survival rates for adult cardiac arrest. The integration of automated external defibrillators (AEDs) into public spaces, workplaces, and healthcare settings has become more widespread. Rescuers are encouraged to locate and use AEDs as soon as possible, as these devices can analyze the heart's rhythm and deliver a shock if necessary, potentially restoring a normal heart rhythm.


Continuous Chest Compressions

In certain situations where advanced airway management is not immediately available, the guidelines recommend the implementation of continuous chest compressions. This approach involves minimizing interruptions in chest compressions and delivering compressions continuously without the traditional 30:2 compression-to-ventilation ratio. This technique aims to maintain consistent blood flow and optimize cardiac perfusion during resuscitation efforts.


These changes in Adult CPR guidelines reflect the ongoing commitment to improving outcomes for individuals experiencing cardiac arrest. By staying updated with the latest guidelines and receiving regular CPR training, rescuers can confidently administer high-quality CPR and increase the chances of survival until advanced medical care is available.


What Are The Recommended New CPR Techniques For Adults?

The recommended CPR techniques for adults include the following steps:

  1. Check the surroundings for safety and ensure that the person is unresponsive and not breathing normally.
  2. Call for emergency medical services immediately or ask someone else to do so.
  3. Perform 30 compressions at a rate of 100 to 120 compressions per minute with a depth of 2.4 inches or 6cm deep
  4. After 30 compressions, deliver two rescue breaths, each lasting about 1 second, and watch for the chest to rise with each breath.
  5. Perform cycles of 30 compressions and 2 breaths until the person shows signs of life, an automated external defibrillator (AED) becomes available, or trained medical personnel take over.
Related Article:
Adult CPR: How to Perform CPR on Adults

Pediatric CPR Guidelines

Pediatric CPR guidelines provide specific recommendations for performing cardiopulmonary resuscitation on infants and children. These guidelines are designed to address the unique physiological and anatomical differences between adults and pediatric patients, ensuring the delivery of effective and age-appropriate resuscitation measures.


Age-Appropriate Techniques

One important aspect of pediatric CPR guidelines is the emphasis on age-appropriate techniques. The guidelines distinguish between infants (birth to 1 year old) and children (1 year to puberty) to account for variations in body size, developmental stage, and responsiveness. Rescuers are guided on the proper compression depth, rate, and ventilation techniques for each age group, ensuring the best outcomes during pediatric resuscitation efforts.


CPR Sequence and Priorities

The CPR guidelines outline a sequence of steps for pediatric CPR, similar to adult CPR. This includes assessing the child's responsiveness, activating emergency medical services, and starting CPR with a combination of chest compressions and rescue breaths. The specific compression-to-ventilation ratio for pediatric patients varies depending on the number of rescuers involved, with an emphasis on maintaining adequate circulation and oxygenation.


Modification For Untrained Rescuers

Recognizing that not all individuals may have received formal CPR training, the guidelines provide simplified techniques for untrained rescuers. These techniques focus primarily on chest compressions, highlighting the importance of early and continuous compressions until professional help arrives. This modification acknowledges the vital role that bystanders can play in initiating CPR and highlights the significance of early intervention in improving outcomes for pediatric patients in cardiac arrest.


Use of Automated External Defibrillators (AEDs)

Similar to adult CPR, the guidelines also promote the use of automated external defibrillators (AEDs) in pediatric resuscitation. AEDs are capable of analyzing the child's heart rhythm and delivering a shock if necessary. They are specifically equipped with pediatric pads or attenuators to ensure appropriate energy levels for pediatric patients. The guidelines emphasize the importance of locating and utilizing AEDs as soon as possible in cases of pediatric cardiac arrest.


Teamwork and Training

Pediatric CPR guidelines highlight the significance of teamwork and coordination among rescuers. In situations where multiple rescuers are available, synchronized efforts are encouraged to optimize the quality of CPR and minimize interruptions. The guidelines also emphasize the importance of regular training and refreshing CPR skills, particularly for healthcare professionals and individuals who frequently interact with children.

Following the pediatric CPR guidelines is crucial in providing effective resuscitation for infants and children in need. By familiarizing themselves with these guidelines, healthcare professionals, caregivers, and bystanders can be better prepared to respond to pediatric cardiac emergencies and potentially save lives.


What Are The Recommended CPR Techniques For Pediatric Patients?

Performing CPR on pediatric patients requires specific techniques tailored to their age and size. Here is an overview of the steps involved in performing CPR on pediatric patients:

  1. Assess the situation, evaluate the surroundings, and ensure personal safety.
  2. When you are alone,call 911 after you’ve done 2 minutes of CPR. If someone else is present, ask the person to call 911 while you are preparing for CPR
  3. Check for Breathing and Pulse. If the child has no pulse, not breathing, or only gasping, proceed with initiating CPR immediately, starting with chest compressions followed by rescue breaths
  4. For a single rescuer, the CPR ratio is 30 compressions to 2 breaths, for two rescuers, the ratio is 15 compressions to 2 breaths.
  5. Continue performing uninterrupted CPR until AED is available, emergency medical services (EMS) personnel arrive on the scene or the child victim shows any signs of life.

Specific Techniques and Considerations For Infant CPR

  • Perform CPR on an infant using two fingers instead of the heel of the hand to deliver chest compressions.
  • Adjust compression depth to about 1.5 inches (4 cm) for infants.
  • Use a compression-to-ventilation ratio of 30:2 for single-rescuer CPR and 15:2 for two-rescuer CPR.
  • Prioritize chest compressions and ensure minimal interruptions during CPR.
  • Use an AED with pediatric pads and follow the manufacturer's instructions for use on infants.
  • Adapt techniques for opening the airway, including using a head tilt-chin lift maneuver for infants without suspected trauma and a modified jaw thrust maneuver for infants with suspected trauma.
  • Use a CPR feedback device, if available, to guide the quality of CPR and provide real-time feedback.
  • Monitor the infant's response to CPR and adjust techniques as necessary.

Related Article:
Infant CPR: How to Perform CPR on Infants (0-1 year old)

CPR is The Future of Rescue Training

First aid responders and paramedics in Washington State have been taught a new method of CPR called High-Performance CPR. The emphasis is on administering CPR immediately and continuously until signs of life are observed. Hands-Only CPR is used, with effective compressions given at a rate of 100-120 compressions per minute without pauses. This approach helps speed up blood flow and reduces brain damage in unconscious victims. The Emergency Medical Team will prioritize CPR over other medical activities upon reaching a cardiac arrest victim. EMS Medical Program Director Mr. Kevin Hodges said that "For every minute that goes by without CPR after a cardiac arrest, 10% of those people will die,"


High-Performance CPR

The implementation of High-Performance CPR in Kennewick, Washington has made CPR the top priority activity for cardiac arrest victims, surpassing other tasks like moving the patient or using an AED. Kennewick paramedical personnel Mr. Eric Nilson said, "We usually get out of the rig, everybody grabs the equipment, and we all go inside. The new focus is that as soon as they stop the vehicle, a person jumps off that rig and immediately runs to wherever the patient is, identifies the patient in cardiac arrest, and immediately starts CPR".

During statistical analysis, Paramedics immediately start CPR upon arrival, resulting in a success rate of 46%, compared to 15% with previous methods. The goal is to achieve a 75% success rate in the future. Other countries are adopting this methodology, and emergency medical service professionals are trained in proper chest compression techniques and rates based on the victim's weight to improve CPR administration.


Changes in the Delivery of CPR Due to COVID-19

Cardiopulmonary Resuscitation is a critical lifesaving procedure for cardiac arrest patients. However, high aerosol-generating can put first aid responders and health workers at an increased risk of infection.


Some of the factors are:

  • CPR involves teams working closely together
  • The procedure is high aerosol-generating
  • Cardiac arrest exerts a lot of pressure on those involved and could lead to compromise to recommended precautions standards.


Covid-19 patients are at risk for developing cardiopulmonary arrest and cardiorespiratory problems. If a patient experiences these issues, they will require basic life support. In some cases, advanced life support may also be necessary. The decision to provide CPR will be based on factors such as the victim's age, underlying illnesses, and other health conditions, which will determine the victim's chances of survival.


New Guidelines for Performing CPR on COVID-19 Patients

To ensure the safety of rescuers while providing care to COVID-19 patients, the American Heart Association and other organizations have issued new guidelines for performing CPR:

  1. Prioritize hands-only CPR for essential life support. This approach is safer, but healthcare workers should wear full personal protective equipment (PPE).
  2. Cover the victim's mouth and nose with a cloth or towel when performing CPR. In a hospital setting, COVID-19 patients experiencing cardiac arrest should be resuscitated and defibrillated.
  3. Use automated external defibrillators (AEDs) as soon as they are available. Studies indicate that AED usage does not increase the generation of aerosols.
  4. Ensure the use of proper PPE. All rescuers should wear recommended PPE, including gowns, gloves, eye protection, and respirators, according to institutional guidelines, before entering the scene.
  5. Utilize mechanical CPR devices instead of manual methods to reduce the number of professionals needed for a specific patient.
  6. Minimize the number of healthcare personnel involved in resuscitation efforts, particularly those entering isolation rooms, to decrease exposure to the virus.
  7. Keep doors closed during resuscitation to limit the spread of the virus to surrounding areas.
  8. Communicate the COVID-19 status of the victim to new healthcare workers arriving at the scene. All healthcare workers within the facility should be informed. When contacting emergency response teams, responders should also inform them if the patient is known to have the infection.
  9. Intubated patients should remain on mechanical ventilators with high-efficiency particulate air (HEPA) filters to reduce aerosolization and maintain a closed circuit.
  10. Adjust ventilation to pressure control mode and adjust the fraction of inspired oxygen (FiO2) to 0.1. For adults, set the pressure to allow for chest rise of 6 mL/kg, and for neonates, set it to 4-6 mL/kg.
  11. Intubation procedures are considered highly aerosol-generating. Healthcare providers are advised to use cuffed endotracheal tubes connected to ventilators with HEPA filters in the exhaled gas path and inline suction catheters. This setup reduces the risk of aerosol generation.


Following these guidelines will help ensure the safety of healthcare workers while providing CPR to COVID-19 patients.

How Often Are CPR Guidelines Updated?

CPR guidelines are typically reviewed and updated every 5 years to reflect the latest scientific evidence and advancements in resuscitation techniques. These updates ensure that healthcare providers and the general public have access to the most current and effective CPR guidelines. Additionally, in some cases, interim updates or specific updates for certain topics may be released to address emerging research or changes in practice. It's important to stay informed about the latest CPR guidelines by accessing reputable sources and receiving regular CPR training and certification.


Who Makes the Changes In CPR Guidelines and On What Basis Are Changes Made?

The changes in CPR guidelines are typically made by international organizations such as the American Heart Association (AHA), the European Resuscitation Council (ERC), and the International Liaison Committee on Resuscitation (ILCOR). These organizations consist of experts in the field of resuscitation, including healthcare professionals, researchers, and scientists.

The changes in CPR guidelines are based on a thorough review of the latest scientific evidence and research studies. These organizations systematically analyze and evaluate the available data to determine the most effective and evidence-based practices for resuscitation. They consider factors such as outcomes from clinical trials, studies on resuscitation techniques, and advancements in resuscitation equipment and technology.


How Can the Public Stay Informed About the Current CPR Guidelines?

To stay informed about the current CPR guidelines, the public can follow these steps:

  • Regularly visit the official websites of reputable organizations that set and update the CPR guidelines, such as the American Heart Association (AHA), the International Liaison Committee on Resuscitation (ILCOR), or the American Red Cross. These organizations often publish the latest guidelines, updates, and educational resources related to CPR.
  • Stay connected with CPR training providers in your area. They typically receive updates on the guidelines and incorporate them into their training programs. Attend refresher courses or recertification classes to ensure you are up to date with the latest techniques and protocols.
  • Keep an eye on news and media outlets for any announcements or articles related to CPR guidelines updates. These sources often cover major changes or advancements in resuscitation techniques.
  • If you have received CPR training in the past, consider participating in continuing education programs or refresher courses. These programs often provide updates on CPR guidelines and offer an opportunity to practice and reinforce your skills.

Remember, it is important to rely on credible sources for accurate and up-to-date information on CPR guidelines. Always prioritize the guidelines set by recognized organizations and seek guidance from healthcare professionals when needed.

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