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CPR Guidelines

Quick Tips #314

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Sudden cardiac arrest (SCA) is an unexpected loss of heart function, breathing and consciousness. When SCA occurs, blood stops flowing to the brain, heart and the rest of the body. SCA happens without warning and requires immediate emergency treatment. It affects more than 1000 people outside hospitals each day in the United States and only 10 percent survive. With fast, appropriate medical care, survival is possible. When bystanders provide cardiopulmonary resuscitation (CPR) and use an automated external defibrillator (AED) before emergency personnel arrive, approximately 40 percent of victims survive. Unfortunately, only one-third (32 percent) of SCA victims receive bystander CPR and just two percent are treated with an AED by bystanders.

Cardiopulmonary Resuscitation (CPR)

CPR is a lifesaving procedure performed when someone’s breathing or heartbeat has stopped, as in cases of sudden cardiac arrest, electric shock or drowning. CPR is a combination of chest compressions, which help keep the person’s blood circulating, and rescue breathing, which provides oxygen to the person’s lungs. Time is of the essence when an unconscious person is not breathing. Permanent brain damage can begin after only four minutes without oxygen, and death can occur as soon as four to six minutes later.

The following steps for performing CPR on an adult victim are based on instructions from the 2010 American Heart Association Guidelines for CPR and ECG:

  • Before starting CPR, check for responsiveness. Shake or tap the person gently. See if the person moves or makes a noise. Shout “Are you OK?”
  • Call 911 if there is no response.
  • Carefully place the person on his/her back.
  • Perform chest compressions:
    • Place the heel of one hand on the breastbone, right between the nipples.
    • Place the heel of your other hand on top of the first hand.
    • Position your body directly over your hands.
    • Give 30 fast and hard chest compressions. Press down about two inches into the chest and let the chest rise completely each time.
  • Open the airway by lifting up the person’s chin with two fingers while tilting the head back by pushing on the forehead with the other hand.
  • Look, listen and feel for breathing. Place your ear close to the person’s mouth and nose. Watch for chest movement. Feel for breath on your cheek.
  • If the person is not breathing or has trouble breathing:
    • Cover his/her mouth tightly with your mouth.
    • Pinch the nose closed.
    • Keep the chin lifted and head tilted.
    • Give two one-second rescue breaths; each breath should make the chest rise.
  • Continue CPR (30 chest compressions followed by two breaths, then repeat) until the person recovers or emergency help arrives.

It is far better to do something than to do nothing at all. The American Heart Association suggests:

  • If you’re not trained in CPR, then provide hands-only CPR. That means uninterrupted chest compressions at a rate of 100 per minute until emergency help arrives.
  • If you’re trained, but rusty, do chest compressions at a rate of 100 per minute until emergency help arrives.
  • If you’re well-trained and confident in your ability, begin with 30 chest compressions before checking the airway and doing rescue breathing.
Chain of Survival

The Chain of Survival is a five-step process for providing treatment to victims of SCA. More people can survive SCA if the following steps occur in rapid succession:

Quick execution of each step is critical because the chances of survival decrease 7 to 10 percent with each passing minute.

Good Samaritan Laws

Most states have enacted Good Samaritan Laws to encourage people to help others in emergency situations. These laws give legal protection to people who provide emergency care to ill or injured persons. They require that the Good Samaritan use common sense and a reasonable level of skill not to exceed the scope of the individual’s training in emergency situations.


Many people are fearful of contracting an infectious disease when performing rescue breathing. Even though the risk is minimal, special plastic barrier devices can help prevent contact with the person’s mouth. If the bystander doesn't have a barrier available at the time and doesn't want to perform rescue breathing, then perform continuous chest compressions at a rate of 100 compressions per minute with the airway open for passive ventilation.

Commonly Asked Questions
Q: Is sudden cardiac arrest the same as a heart attack? A: No. Sudden cardiac arrest is not the same as a heart attack. A heart attack occurs if blood flow to part of the heart muscle is blocked. During a heart attack, the heart usually doesn't suddenly stop beating. However, sudden cardiac arrest may happen after or during recovery from a heart attack.

Q: What is an automated external defibrillator? A: An automated external defibrillator (AED) is a portable, user-friendly electronic device that automatically diagnoses potentially life-threatening heart rhythms. If the AED detects a problem that may respond positively to an electric shock, it permits a shock to be delivered to help restore a normal heart rhythm.

Q: If I'm alone with someone who collapses, when do I call 911? A: If you are alone and have immediate access to a telephone, call 911 before beginning CPR, unless you think the person has become unresponsive because of suffocation (such as from drowning). In this special case, begin CPR for one minute and then call 911 or the local emergency number.


National Institute of Health – National Heart, Lung and Blood Institute – Sudden Cardiac Arrest

National Institute of Health – U.S. National Library of Medicine

Mayo Clinic – Diseases and Conditions – Sudden Cardiac Arrest

Heart Disease and Stroke Statistics-2012 Update: A Report From the American Heart Association, Circulation. 2012: 125(1):188-197.

Sudden Cardiac Arrest Foundation

2010 American Heart Association Guidelines for CPR and ECG

Occupational Safety and Health Administration 29 Code of Federal Regulations 1910.151 Medical Services and First Aid Standard

(Rev. 4/2015)

Find even more information you can use to help make informed decisions about the regulatory issues you face in your workplace every day. View all Quick Tips Technical Resources at

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Please Note:
The content in this newsletter is intended for general information purposes only. This publication is not a substitute for review of the applicable government regulations and standards, and should not be construed as legal advice or opinion. Readers with specific compliance questions should refer to the cited regulation or consult with an attorney.

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