CPR Step by Step: How to Perform Chest Compressions Until Help Arrives

Why Learning CPR Could Save Someone's Life

Cardiac arrest kills approximately 350,000 people in Europe each year. About 70% of cardiac arrests happen outside hospitals — at home, in the street, at work. Survival rates drop by 7-10% for every minute without CPR.

The single biggest predictor of survival? Whether a bystander starts CPR immediately.

In most European countries, fewer than 30% of cardiac arrest victims receive bystander CPR. This is a preventable tragedy. CPR isn't difficult — it requires a few minutes of learning and the willingness to act.

This guide gives you the skills to perform effective CPR.

Step 1: Recognize Cardiac Arrest

Before starting CPR, confirm it's needed:

The person is:

1. Unresponsive (no reaction to shouting their name and shaking their shoulder)
2. Not breathing normally (no breathing, or only irregular gasping — gasping is NOT normal breathing)

Do NOT start CPR if:

• The person is conscious and responding
• The person is breathing normally

If uncertain: Start CPR. The risk of performing CPR on someone who doesn't need it is very low. The risk of NOT performing CPR on someone who does is death.

Step 2: Call Emergency Services Immediately

Before starting CPR, call 112 (EU), 911 (US), or 999 (UK).

If you're alone:

• Call first, then start CPR
• Put the phone on speaker so the dispatcher can guide you

If others are present:

• Point at a specific person: "You — call 112 now and come back when you've called"
• Start CPR immediately while they call
• Ask someone to find an AED (Automated External Defibrillator) if available nearby

Why this order matters: Emergency dispatchers can guide untrained bystanders through CPR. They stay on the line and can answer your questions.

Step 3: Position the Person

• Lay the person on their back on a firm, flat surface
• Kneel beside their chest
• Remove any obvious obstructions from around the person

Step 4: Start Chest Compressions

Hand placement:

1. Place the heel of one hand on the center of the chest (lower half of the breastbone — not the ribs, not the stomach)
2. Place your other hand on top, fingers interlaced
3. Straighten your arms — don't bend your elbows

Compression technique:

• Push down hard and fast
• Depth: 5-6 cm (about 2 inches) — this is deeper than most people expect
• Rate: 100-120 compressions per minute
• Count aloud: "1, 2, 3, 4..." at a steady beat
• Allow the chest to fully rise back up between compressions — don't lean on the chest
• Don't stop to check for pulse

The beat of "Stayin' Alive" by the Bee Gees (or "Another One Bites the Dust" by Queen) is approximately the right rate. Many CPR instructors recommend humming these songs.

Step 5: Rescue Breaths (If Trained and Willing)

Current guidelines recommend:

• Trained adults who are willing: 30 compressions, then 2 rescue breaths (30:2 ratio)
• Untrained adults, or those who are unwilling: Hands-only CPR (compressions only) is effective and highly preferable to no CPR

If giving rescue breaths:

1. After 30 compressions, tilt the head back and lift the chin to open the airway
2. Pinch the nose closed
3. Seal your lips around the person's mouth
4. Blow steadily for 1 second — visible chest rise indicates effective breath
5. Give a second breath
6. Return immediately to compressions

Note: Current evidence shows that for adult cardiac arrest not caused by drowning or suffocation, hands-only CPR (no rescue breaths) is nearly as effective as CPR with rescue breaths. Do not refuse to do CPR because you're unwilling to give rescue breaths — compressions-only CPR saves lives.

Step 6: Use an AED If Available

AEDs (Automated External Defibrillators) are increasingly available in public spaces — airports, train stations, shopping centers, sports facilities.

With an AED:

1. Continue CPR while someone sets up the AED
2. Turn on the AED — it will give verbal instructions
3. Attach pads as shown in diagrams on the pads
4. Stand clear when the AED says to analyze/shock
5. Resume CPR immediately after the shock (or if no shock recommended)

AEDs are designed to be used by untrained bystanders. They will NOT shock someone who doesn't need it. Use them — they dramatically improve survival rates.

Step 7: Continue Until Help Arrives

Do not stop CPR until:

• Emergency services take over
• The person starts breathing normally
• You are physically unable to continue

If you become exhausted: Ask someone else to take over. Rotate every 2 minutes if possible — fatigue significantly reduces compression quality.

Common CPR Mistakes and How to Avoid Them

Mistake 1: Not pushing hard enough Effective compressions must be 5-6 cm deep. This feels deeper and stronger than most untrained people expect. Lean into it with your body weight, not just your arms.

Mistake 2: Stopping to check for pulse or breathing Don't interrupt compressions to check. If you need to stop for an AED shock, restart immediately.

Mistake 3: Leaning on the chest between compressions Allow full chest recoil after each compression. Your hands should maintain light contact but not press down between compressions.

Mistake 4: Compressing too slowly 100-120 compressions per minute feels fast. Count aloud to maintain the rate.

Mistake 5: Delaying out of fear of "hurting someone" Rib fractures from CPR are possible, especially in older adults. They are survivable. Cardiac arrest without CPR is not. This should never be a reason to hesitate.

After Successful Resuscitation

If the person regains consciousness:

• Place them in the recovery position (on their side, airway clear) if breathing
• Stay with them until emergency services arrive
• Keep them calm and still

Taking a CPR Course

This guide provides the theoretical foundation. Nothing replaces hands-on practice with a manikin.

Recommended: Take a certified CPR course. They take 2-4 hours and cover:

• Adult CPR
• Child CPR (different techniques)
• Infant CPR
• AED use
• Choking response (Heimlich maneuver)

Most Red Cross chapters, fire departments, and community organizations offer affordable or free courses. Certification typically lasts 2 years.

The skill you learn in those 2-4 hours could save a life you care about. It's among the highest-value personal preparedness investments you can make.