How to Perform CPR: A Step-by-Step Life-Saving Guide
Learn how to perform CPR with this step-by-step life-saving guide. Understand when and how to act in emergencies to help adults, children, and infants until professional help arrives.
Written by Dr. J T Hema Pratima
Reviewed by Dr. Shaik Abdul Kalam MD (Physician)
Last updated on 13th Sep, 2025
Cardiac arrest can strike anyone, anywhere, at any time—a colleague at work, a loved one at home, or a stranger in a public space. In these critical moments, before professional medical help arrives, the actions of a bystander are the most crucial link for survival. Cardiopulmonary Resuscitation, or CPR, is that vital link. It’s a simple yet powerful procedure that can double or even triple a person's chance of survival after cardiac arrest. This guide demystifies CPR, breaking it down into clear, actionable steps for everyone. We will cover everything from the basics of chest compressions to using an AED, empowering you with the knowledge to act confidently in a life-or-death situation.
What is CPR and Why is it So Critical?
CPR is an emergency procedure performed when someone's heart stops beating. It combines chest compressions—which manually pump the heart—and rescue breaths—which provide oxygen—to keep oxygenated blood flowing to the brain and other vital organs. This process is essential because when the heart stops, the brain begins to die within minutes due to a lack of oxygen. Every minute without CPR decreases the survival chance by 7-10%. By performing CPR, you are essentially acting as the heart and lungs for the victim, buying precious time until advanced medical care and defibrillation can restart the heart.
The Life-Saving Science Behind Chest Compressions
The core of modern CPR is high-quality chest compressions. The concept, known as "perfusion," is about creating artificial circulation. When you push hard and fast on the center of the chest, you are directly compressing the heart against the spine. This action pushes blood out of the heart to the brain and coronary arteries. When you release the pressure, the chest recoils, allowing the heart to refill with blood. This continuous cycle of compression and recoil is what keeps the person alive. It’s physically demanding but incredibly effective, making "push hard and push fast" the mantra of effective CPR.
The Initial Steps for Safety and Assessment
Before you rush to aid a victim, your first responsibility is to ensure you don't become one yourself. The initial assessment is a rapid but crucial process.
Step 1: Ensure the Scene is Safe
Quickly scan the area for immediate dangers like traffic, fire, electrical wires, or unstable structures. Do not enter an unsafe scene; instead, call for professional help immediately.
Step 2: Check for Responsiveness
Approach the person and tap them firmly on the shoulder. Shout loudly, "Are you okay? Are you okay?" Look for any movement, groaning, or eye opening. If they do not respond, they are unconscious and need help.
Step 3: Call for Help and Get an AED
If the person is unresponsive, shout for someone nearby to call emergency services (like 108 or your local number) and to find an Automated External Defibrillator (AED). If you are alone, call emergency services yourself (putting the phone on speaker) and then begin compressions. An AED is a portable device that can analyse the heart's rhythm and deliver an electric shock if needed, and it is absolutely critical for survival.
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How to Perform CPR on an Adult?
Here’s how you can perform CPR on an adult:
Hands-Only CPR for Untrained Rescuers
If you are untrained, unsure, or unwilling to give rescue breaths, the American Heart Association recommends Hands-Only CPR. It’s proven to be highly effective for teens and adults who suddenly collapse.
1. Kneel beside the person on a firm surface.
2. Place the heel of one hand on the center of the chest, on the lower half of the breastbone.
3. Place your other hand on top and interlock your fingers.
4. Position your shoulders directly over your hands with your arms straight.
5. Push hard and fast. Compress the chest at least 2 inches (5 cm) deep, at a rate of 100-120 compressions per minute. A good rhythm to follow is the beat of the classic disco song "Stayin' Alive" by the Bee Gees.
6. Continue compressions without pausing until help arrives or an AED is ready to use.
Conventional CPR with Rescue Breaths
For those trained and confident, conventional CPR includes rescue breaths.
1. Perform 30 chest compressions as described above.
2. After 30 compressions, give 2 rescue breaths:
• Open the airway using the head-tilt/chin-lift maneuver (tilt the head back and lift the chin).
• Pinch the nose closed.
• Take a normal breath, make a complete seal over the person’s mouth with yours, and blow in for about one second, just enough to make the chest visibly rise.
3. Continue the cycle of 30 compressions and 2 breaths.
The Correct Hand Placement and Compression Technique
Incorrect hand placement is a common CPR mistake. Your hands must be on the center of the chest, on the sternum (breastbone). Placing hands too high or too low is ineffective and can cause injury. Lock your elbows and use your upper body weight to push, not just your arm muscles. Allow for full chest recoil between compressions to let the heart refill with blood.
How to Give Effective Rescue Breaths
The goal is to see the chest rise. If it doesn't, reposition the head (re-tilt) and try again. Avoid breathing too forcefully or too long. Each breath should be a gentle, one-second puff of air. If you are concerned about infectious disease, a pocket mask or face shield is a good item to keep in your first-aid kit, but do not delay compressions to look for one.
How to Perform CPR on a Child or Infant?
The fundamental principles remain the same, but the technique is modified for a smaller body. Child CPR is for children aged 1 to puberty, and infant CPR is for those under 1 year.
Key Differences in Technique for Pediatric Patients
Compressions: For a child, use one or two hands (depending on the child's size) and compress about 2 inches deep. For an infant, use two fingers (index and middle) and compress about 1.5 inches deep.
• Breaths: For an infant, cover both the mouth and nose with your mouth when giving rescue breaths.
• Cause: In children, cardiac arrest is often due to a breathing problem first. Therefore, if you are alone, provide 2 minutes of CPR (about 5 cycles) before calling for help.
Using an Automated External Defibrillator (AED)
An AED is designed for public use. It will provide audible, step-by-step instructions.
How to Operate an AED: It's Simpler Than You Think
1. Turn it on and follow the voice prompts.
2. Expose the chest and wipe it dry if sweaty.
3. Attach the pads as shown in the diagram on the pads (one on the upper right chest, the other on the lower left side).
4. Stand clear as the AED analyses the heart rhythm.
5. If a shock is advised, ensure no one is touching the victim and press the shock button.
6. Immediately resume CPR after the shock is delivered. The AED will guide you through the entire process.
When to Stop CPR and Understanding Good Samaritan Laws?
Continue CPR until:
• The person shows obvious signs of life (breathing, moving).
• An AED is ready to use or another trained responder takes over.
• You are too exhausted to continue.
• The scene becomes unsafe.
Good Samaritan laws exist in many countries, including India, to protect bystanders who voluntarily provide reasonable assistance in an emergency from legal liability. Your intent to help in good faith is what matters most.
Common Myths and Mistakes to Avoid During CPR
• Myth: You will break ribs. It's common to feel ribs crack, especially in older adults. A broken rib is survivable; cardiac arrest is not. Do not let this fear stop you.
• Mistake: Not pushing deep or fast enough. Ineffective compressions won't circulate blood properly. Focus on depth and rate.
• Mistake: Pausing too often. Interruptions in compressions stop blood flow. Minimise any pauses.
• Myth: You can be sued. Good Samaritan laws offer significant protection for those acting in good faith.
Conclusion
Understanding CPR transforms you from a bystander into a potential lifesaver. This knowledge is a profound responsibility and a gift you can give to your community. While this guide provides a strong foundation, there is no substitute for hands-on training. Consider taking a certified CPR course to build muscle memory and confidence. Remember, in an emergency, your actions are the first and most critical step in the chain of survival. Don't be afraid to act. Push hard, push fast, and be the help until help arrives.
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Consult Top Specialists
Dr. Dayanashre N
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Dr. Tripti Deb
Cardiologist
40 Years • MBBS, MD, DM, FACC, FESC
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Apollo Hospitals Jubilee Hills, Hyderabad
Consult Top Specialists
Dr. Dayanashre N
General Physician
3 Years • MBBS
Bengaluru
PRESTIGE SHANTHINIKETAN - SOCIETY CLINIC, Bengaluru
Dr. Bhethala Sharan Prakash
General Physician/ Internal Medicine Specialist
5 Years • MBBS MD
Bengaluru
PRESTIGE SHANTHINIKETAN - SOCIETY CLINIC, Bengaluru
Dr. Zulkarnain
General Physician
2 Years • MBBS, PGDM, FFM
Bengaluru
PRESTIGE SHANTHINIKETAN - SOCIETY CLINIC, Bengaluru
Dr. Anand Ravi
General Physician
2 Years • MBBS
Bengaluru
PRESTIGE SHANTHINIKETAN - SOCIETY CLINIC, Bengaluru
Dr. Tripti Deb
Cardiologist
40 Years • MBBS, MD, DM, FACC, FESC
Hyderabad
Apollo Hospitals Jubilee Hills, Hyderabad
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Frequently Asked Questions
1. Can I hurt someone by doing CPR wrong?
It is very difficult to make a person in cardiac arrest worse off. They are clinically dead. Any attempt at CPR, even if not perfect, offers a chance of survival that would otherwise be zero. The risk of injury, like a broken rib, is far outweighed by the benefit of saving a life.
2. Do I need to give rescue breaths if I'm untrained?
No. For adult victims of sudden cardiac arrest, Hands-Only CPR (chest compressions only) is strongly recommended for untrained bystanders. It is easier to perform and remember and can be just as effective as conventional CPR in the first few minutes.
3. How do I perform CPR on a drowning victim?
For a drowning victim, the cause of arrest is typically a lack of oxygen. Therefore, rescue breaths are crucial. After your initial breaths, proceed with the standard 30:2 ratio of compressions to breaths. It is also vital to have someone call for help immediately, as these scenarios require advanced life support.
4. Should I stop compressions to check if the person is breathing?
No. Once you start CPR, you should only stop if the person shows obvious signs of life, an AED is analysing the rhythm, the scene becomes unsafe, or you are relieved by a professional. Do not stop to re-check for breathing periodically.
5. Where can I get certified in CPR?
Many organisations offer certification, including the Indian Red Cross Society, St. John Ambulance, and local hospitals. You can often find courses through a quick web search for 'CPR certification near me.'