How — and when — to perform CPR on infants, kids and adults
Worldwide interest in CPR, also known as cardiopulmonary resuscitation, skyrocketed following Buffalo Bills player Damar Hamlin’s cardiac arrest during a game on Jan. 2, according to the American Heart Association (AHA). The organization reported a 620% increase in page views of its Hands-Only CPR webpages, a 145% increase in page views of its What is CPR? page and a 113% increase in page views of its CPR Course Catalog page.
According to the AHA, about 90% of people who experience cardiac arrests outside of a hospital die. But CPR, especially when done immediately, can double or triple a person’s survival chances.
Dr. Comilla Sasson, vice president for science and innovation for emergency cardiovascular care at the AHA, and a practicing emergency medicine physician in Denver, tells Yahoo Life that CPR — an emergency lifesaving procedure that helps keep blood flowing when the heart stops beating — can extend the possibility that the person will survive once a medical professional attends to them.
How do you know if someone needs CPR?
A person needs CPR when experiencing cardiac arrest, Dr. Holly Andersen, a cardiologist at NewYork-Presbyterian/Weill Cornell, tells Yahoo Life. “They will collapse suddenly and not be responsive, breathe or have a pulse,” she says.
Dr. Jeremy Turlington of VCU Health’s Pauley Heart Center tells Yahoo Life that “if you see someone collapse, you should ask if they are OK, and if there is no response, that is when you should be concerned for a potential cardiac or respiratory arrest — a lack of heartbeat or breathing.”
If the person is unresponsive, Turlington advises calling 911 immediately. If someone is with you, ask them to call 911 instead while you assess the person. First, ensure they're in a safe environment. Next, check for a pulse, preferably in the neck, at the side of the throat or the Adam’s apple. If you don’t feel a pulse, you should start CPR.
Although a person who needs CPR will typically be on the ground, if the person is slumped in a seated position, Dr. Evan Jacobs, associate vice president of specialty care for Conviva Care Center, tells Yahoo Life that you should lower them to the ground if possible before assessing them.
That said, if you don’t know how the person became unconscious and if there is an obvious injury to the head or neck region, avoid shaking or moving them excessively because there could be a spinal cord injury, Dr. Samuel Hahn, an interventional cardiologist at Yale Medicine, tells Yahoo Life.
If the person still has a pulse, Jacobs says, they may not need CPR. This can happen in people with very low blood sugar who may faint, for example.
How to perform CPR on infants
According to Andersen, experts recommend performing CPR with breaths for infants. But first, call 911 or ask someone else to do so if available. Then, “carefully remove any obvious obstruction in the baby’s mouth.”
To do CPR with breaths, “place the infant on a flat surface. Ensure the head is in a neutral position and lift the chin,” Andersen says.
Take a breath, then cover the infant’s mouth or nose with your mouth, ensuring it’s sealed. Then blow a breath steadily into the baby’s mouth or nose, enough to make the chest visibly rise, she explains. “Watch for the chest to fall, then repeat.”
After giving breaths, place two fingers pointed down on the baby’s breastbone, just below the nipples. “Perform two compressions — by pressing down on the chest — per second or 100 to 120 compressions per minute,” explains Andersen. She advises that each compression push the chest down by about one-third of the depth of the infant’s chest.
“After 30 compressions, give two more breaths,” she says. “Continue breaths and compressions in a ratio of 2 breaths for every 30 compressions.”
Sasson says you should continue CPR until the ambulance arrives or until the infant’s heartbeat and breathing return.
How to perform CPR on children
To do CPR for a child, kneel beside them as they lie on their back. With your hands out straight and fingers interlocked, use the palm of your hand to push down hard and fast in the center of the chest, Andersen explains. Do two compressions per second, pressing down about one-third of an inch deep into the child’s chest.
She advises that it’s best to have a song in your head while performing CPR, to keep the beat. “NewYork-Presbyterian Hospital put together a Spotify playlist of songs with 100 to 120 bpm, the right beat to perform CPR,” says Andersen. You can find the playlist on this Spotify page. The hospital also has a video at HandsOnly.org that teaches you how to do CPR in less than a minute.
You can also perform CPR with breaths for children by following the same steps as you would for an infant. However, instead of using two fingers to do the compressions, you would use the heel of your hand for children up to 8 years old and two hands for older children, explains Sasson.
How to perform CPR on teens and adults
Ensure the person is lying flat on their back before starting CPR. Kneel beside them and place the heels of your hands, one on top of the other, over their breastbone at the center of the chest, Turlington says.
“Using your body weight and not just your arms, with your shoulders directly over your hands, start doing chest compressions,” he says. Turlington suggests pressing about 2 inches deep with each compression and allowing the chest to return to a normal position between compressions.
Do the compressions at 100 to 120 per minute, which for reference is the tempo of the song “Stayin’ Alive” by the Bee Gees (or any of the other songs on the NewYork-Presbyterian Spotify playlist). Turlington says you should keep going until someone else comes to relieve you or if the person starts breathing on their own.
In some cases, you can break a person’s ribs performing CPR. Though unpleasant, Turlington explains, you’re still saving their life. According to Jacobs, seniors are more likely to have rib fractures from chest compressions. If the person is thin or frail, he advises you to press their chest at 2 inches deep only.
Also, chest compressions are tiring, notes Turlington. So, if you have help, switch places every minute or two to ensure each person gets a rest and can perform better during their turn.
How does CPR actually work?
During cardiac arrest, the heart stops pumping blood, and the person stops breathing, Hahn explains. However, notes Turlington, the lungs have a reserve of oxygen that can last for a few minutes after a person stops breathing.
CPR works because it mimics the natural squeezing of the heart. “By performing CPR, you push blood out of the heart to the rest of the body, including the brain,” Turlington explains.
When you release the compression during CPR, “the heart recoils, and blood can fill back into the heart for you to pump out again with the next compression,” he says. As you continue compressions at 100 to 120 per minute, blood continues circulating to the brain and other organs to maintain blood flow until medical help arrives to restore the contractions of the heart.
However, after a few minutes, the stored oxygen runs out, and the person will need oxygen, Hahn says. Still, “hands-only CPR is better than nothing and better than incorrectly performing full CPR with rescue breathing,” he says. Hence, Hahn advises getting emergency medical services by calling 911 as soon as possible.
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