This guide is for students enrolled in our AHA BLS Provider course (healthcare). For lay-rescuer / Heartsaver students, see the [First Aid + CPR Study Guide](first-aid-cpr-study-guide.html) instead.

Important facts to know about CPR

  • If the victim has been in water or the chest is wet, wipe dry before attaching AED pads
  • Adults: compress at least 2 inches but not deeper than 2.4 inches
  • Children: compress ⅓ chest depth or about 2 inches
  • Infants: compress ⅓ chest depth or about 1.5 inches
  • An AED helps the heart return to a normal cardiac rhythm
  • For choking victims who become unresponsive, always look for an object in the mouth before a rescue breath
  • For unresponsive victims gasping or not breathing normally with no pulse, start CPR
  • Infant choking: provide continuous sets of 5 back slaps followed by 5 chest thrusts
  • Unconscious choking infant: call 911, start CPR, look in the mouth before each rescue breath
  • Compress at a rate of 100 to 120 times per minute
  • Ensure complete chest recoil between compressions
  • Turn on the AED first, then follow prompts
  • A hairy chest may need shaving before AED pad attachment
  • Monitor chest rise carefully when using a bag-valve mask
  • Single-rescuer child/infant CPR: 30 compressions then 2 rescue breaths
  • Two-rescuer child/infant CPR: 15 compressions then 2 rescue breaths
  • Multiple rescuers should alternate compressions every 2 minutes
  • Push too deep rather than too shallow
  • Clear roles and team responsibilities improve function
  • Team members should know limitations and request help

BLS CPR main components

  1. Compressions
  2. Airway
  3. Breathing

Adult Chain of Survival

In hospital:

  • Surveillance, prevention, treatment of pre-arrest conditions
  • Immediate recognition of cardiac arrest & EMS activation
  • Early CPR with emphasis on chest compressions
  • Rapid defibrillation
  • Multidisciplinary post cardiac arrest care

Out of hospital:

  • Immediate recognition of cardiac arrest & EMS activation
  • Early CPR with emphasis on chest compressions
  • Rapid defibrillation with AED
  • Effective advanced life support
  • Multidisciplinary post cardiac arrest care

Adult 1-rescuer CPR

  • Ensure scene is safe
  • Check responsiveness by tapping and shouting, "Are you OK?"
  • If no response, activate EMS (call 911) and send for AED
  • Assess for normal breathing and pulse presence
  • No pulse or breathing: begin 30 chest compressions minimum 2 inches deep, no deeper than 2.4 inches
  • Give 2 breaths (1 second each) watching chest rise; avoid over-ventilation
  • Continue CPR until help arrives or victim revives
  • Push hard, push fast: compress at a minimum rate of 100 to 120 compressions per minute, allowing full chest recoil
  • Attach AED ASAP while minimizing compression interruptions

Adult 2-rescuer CPR

  • Ventilator determines responsiveness; if no response, activates EMS and calls for AED
  • Ventilator checks for pulse and breathing
  • If victim has pulse: ventilator provides rescue breaths at 1 breath every 5–6 seconds (about 10–12 per minute), delivered over 1 second with chest rise
  • If victim has no pulse: compressor starts chest compressions at 30:2 ratio, 100–120/min, depth at least 2" and no deeper than 2.4"
  • Ventilator can check pulse during compressions
  • Switch positions every 5 cycles or every 2 minutes of CPR

Advanced airway

Once an advanced airway is in place, do not stop compressions for breaths. Perform continuous compressions with 10 breaths per minute (every 6 seconds). Switch positions every 2 minutes.

Pediatric Chain of Survival

  • Early recognition and prevention
  • Rapid EMS activation or call 911
  • High-quality CPR
  • Advanced resuscitation
  • Post-cardiac arrest care
  • Recovery

Child 1-rescuer CPR

  • Ensure scene is safe
  • Determine responsiveness by tapping and shouting
  • If unresponsive, shout for help and activate EMS via cell phone if available
  • Assess for normal breathing and check pulse
  • For sudden witnessed collapse: may leave to call 911. For unwitnessed collapse without cell phone: do 2 minutes CPR before calling 911
  • No detectable pulse or pulse less than 60 beats/min: start chest compressions at lower breastbone, depth ⅓ chest body or about 2"; do 30 compressions
  • Give 2 breaths (1 second each) watching chest rise
  • Continue CPR at 30:2 ratio until help arrives
  • Push hard, push fast at minimum 100 to 120 compressions per minute
  • Allow full chest recoil after each compression
  • Minimize compression interruptions
  • Attach AED ASAP

Child 2-rescuer CPR

  • Ratio: 15 compressions to 2 breaths, rate 100–120/min
  • Ventilator at head; Compressor at chest
  • Ventilator determines responsiveness; if no response, Compressor or bystander calls 911
  • Check pulse and breathing (minimum 5 seconds; maximum 10 seconds)
  • If child has pulse > 60 beats/min: ventilator provides rescue breaths at 1 breath every 2–3 seconds (about 20–30 per minute); recheck pulse every 2 minutes
  • If child lacks normal pulse or pulse < 60 beats/min: compressor starts chest compressions using heel of one or two hands at 15:2 ratio, 100–120/min, depth ⅓ child's body or 2"
  • Switch places and reassess after 5 cycles

Infant CPR (0–1 year)

Infant 1-rescuer CPR

  • Ensure scene is safe
  • Determine responsiveness by tapping and shouting
  • If unresponsive, shout for help and activate EMS via cell phone if available
  • Assess for normal breathing and check pulse
  • For sudden witnessed collapse: may leave to call 911. For unwitnessed without cell phone: do 2 minutes CPR before calling 911
  • No detectable pulse or pulse < 60 beats/min: start chest compressions at depth ⅓ chest body or about 1.5"; do 30 compressions at 100–120/min
  • Check breathing and pulse for 5–10 seconds (brachial or femoral pulse)
  • If victim lacks pulse > 60 beats/min: start chest compressions using heel of one hand or two thumb-encircling hands technique
  • Activate EMS or call 911 after first 5 cycles if no cell phone or bystander
  • Return to infant and continue CPR
  • If infant has pulse > 60 beats/min: provide rescue breaths

Infant rescue breaths

  • 1 breath every 2–3 seconds for about 20–30 per minute
  • Each breath delivered over 1 second with chest rise
  • Recheck pulse every 2 minutes

Infant 2-rescuer CPR

  • Switch to 15:2 ratio
  • Rate: 100–120/min

AED use

An Automated External Defibrillator (AED) is used when the heart stops beating normally and needs to be reset by an electric shock. The sooner the shock is delivered, the better, as successful defibrillation probability diminishes rapidly over time.

Provide 5 cycles of CPR (30:2 for 2 minutes) before using an AED on a child age 1–8 or an infant under 1 year.

Special considerations

  • Hairy chest: Remove enough hair for good skin contact
  • Dry chest: If visibly wet
  • Implanted device: Place pad at least 1 inch away; never on top of device
  • Medication patch: Remove and wipe area before pad placement
  • Adult AED pads can be used on children and infants; pediatric pads preferred
  • Pediatric pads cannot be used on adults
  • For infants: manual defibrillator preferred. If unavailable, use AED with pediatric pads or pediatric dose attenuator. If neither available, use adult pads.

Adult conscious choking

  • Ask "Are you choking?"
  • Ask "Can you speak?"
  • Ask "Can I help you?"
  • Provide inward and upward abdominal thrusts just above the navel

Adult unconscious choking

  • NO BLIND FINGER SWEEPS
  • Call 911
  • Open airway and remove object if visible; then begin CPR (30:2)
  • Every time the airway opens for breaths, look for the object
  • Continue CPR (30:2)

Child conscious choking

  • Ask "Are you choking?"
  • Ask "Can you speak?"
  • Ask "Can I help you?" (ask parent if applicable)
  • Provide inward and upward abdominal thrust just above the navel

Child unconscious choking

  • NO BLIND FINGER SWEEPS
  • Call for help; send bystander to call 911 or activate EMS
  • Open airway and remove object if visible; begin CPR at 30:2
  • Every time the airway opens for breaths, look for the object
  • Continue CPR with 30:2
  • If no one called 911 or activated EMS, call after 2 minutes of CPR

Infant conscious choking

  • Look for choking signs: bluish skin, lips, or nose; high-pitched noise
  • Pick up infant and give 5 back blows between shoulder blades with head supported and lower than bottom
  • Flip infant and provide 5 chest thrusts just below the nipple line, keeping head lower than bottom
  • Repeat until infant is able to cry or becomes unconscious

Infant unconscious choking

  • NO BLIND FINGER SWEEPS
  • Call for help; send bystander to call 911 or activate EMS
  • Open airway and remove object if visible; begin CPR at 30:2
  • Every time the airway opens for breaths, look for the object
  • Continue CPR at 30:2
  • If no one called 911 or activated EMS, call after 2 minutes or 5 cycles of CPR