Cardiopulmonary resuscitation (CPR)

What is cardiopulmonary resuscitation (CPR)?

Cardiopulmonary resuscitation (CPR) is used in an emergency if someone is not breathing normally, or their heart has stopped (cardiac arrest). This combination of techniques is used:

• chest compressions
• rescue breathing (mouth-to-mouth).

CPR helps keep the blood circulating and delivers oxygen to the body until specialist treatment is available. There is usually enough oxygen still in the blood to keep the brain and other organs alive supported for a few minutes, but it is not circulating unless someone does CPR.

Knowing basic emergency first aid and CPR is important – it can be life-saving. Although there is no guarantee that someone will survive from being given CPR, it does give them a chance when otherwise there would have been none.

Without CPR, it only takes a few minutes for someone’s brain to become injured due to a lack of oxygen.

When to seek help in an emergency

In an emergency situation someone's health can deteriorate quickly. Always seek help for any of these life-threatening signs:

• severe bleeding
• difficulty breathing
• not breathing
• unconsciousness
• burns
• serious accidents or trauma.

Call triple zero (000) for an ambulance in an emergency to get medical assistance. Common emergency situations for adults and children include:

Calling triple zero (000)

Some people hesitate in calling triple zero because they don’t believe their situation qualifies as an emergency. If in doubt, call 000 – the operator will direct you to the help you need.

Emergency phone operators are trained to help you and can provide advice about what you need to do while you're waiting for emergency services to arrive.

What to expect during your call to triple zero (000) – ambulance

When you call triple zero (000), you will be asked which service you require. Tell the operator you need an ambulance. You will then be transferred to an ambulance operator and asked for the following information:

• The location you need the ambulance to respond to. If the address if known, provide this to the operator.
• If the address is not known, be sure to tell the operator any additional information that may assist. This may include street or road names, parks, emergency marker details, or any other landmarks nearby.
• Details of the situation and what has happened.
• How many people require medical assistance.
• The injured person’s age and sex.
• Whether the person is conscious or breathing.

The operator will organise assistance for you while you continue talking on the phone, even though you may not hear them do this.

Answer any of the operator’s questions as this can help the paramedics prepare their response before the ambulance reaches you.

The operator may give you first aid instructions over the phone. If you can, put your phone on loudspeaker.

Do not hang up until the phone operator tells you to.

When is CPR needed?

CPR is most successful when administered as soon as possible. CPR is required when a person is:

• unconscious
• not breathing normally
• not breathing.

A person in cardiac arrest may grunt, snort or take gasping breaths – this is not normal breathing. They still need CPR – don’t wait until they stop breathing.

Although CPR steps are the same for adults and older children, the technique for babies and young children (0-5 years) is slightly different.

DRSABCD (or ‘doctors ABCD’)

The steps involved in CPR are known as DRSABCD:

D – Danger
R – Response
S – Send for help
A – Airway
B – Breathing
C – CPR
D – Defibrillator

You may like to call it ‘doctors ABCD’ (DRS ABCD) so you can remember each step.

Steps before giving CPR to babies and young children

1. D= Danger – look for the source of any danger and make sure you and your child are safe.
2. R= Response – check for a response from your child as if you are trying to wake them up. For instance, speak loudly, gently squeeze them or tickle their feet.
3. S = Send for help if your child is not responding. Call 000 and ask for an ambulance. Don’t leave your child unattended.

The emergency services operator will guide you through CPR until the ambulance arrives.

How to give CPR to babies 0-12 months

This video is available in a version aimed at Aboriginal communities, and also in the following languages:

• والإنعاش القلبي الرئوي (CPR)للرضّع والأطفال الصغار.
• و  احیای قلبی و ریوی (CPR) برای اطفال و کودکان خوردسن
• و احیای قلبی-ریوی (CPR)ویژه اطفال و خردسالان
• និង ការសង្គ្រោះដង្ហើម និងបេះដូងឱ្យដំណើរការឡើងវិញ (CPR)សម្រាប់កូនក្មេង និងកុមារតូច
• 以及婴幼儿心肺复苏术简介
• ਅਤੇ ਕਾਰਡੀਓਪੁਲਮੋਨਰੀ ਰੀਸੁਸਾਇਟੀਸ਼ਨ (CPR) ਛੋਟੇ ਬਾਲਕਾਂ ਅਤੇ ਬੱਚਿਆਂ ਲਈ
• REANIMACIÓN CARDIOPULMONAR (RCP)PARA NIÑOS PEQUEÑOS
• VÀ HỒI SỨC TIM PHỔI (CPR) CHO TRẺ MỚI BIẾT ĐI VÀ TRẺ NHỎ

Aim for 5 sets of 30 chest compressions to 2 breaths in about 2 minutes.

To perform CPR on infants (0-12 months):

1. A=Airways – check your baby’s airways (nose, mouth and throat) are clear. Remove any blockage (such as vomit, blood, food or loose teeth).
2. Make sure your baby is in a neutral position (such as on their back) with their head and neck in line. Do not tilt their head back or lift their chin.
3. B=Breathing – is your child breathing normally? If so, gently roll them onto their side (known as the recovery position).
4. If they are not breathing or breathing abnormally (such as grunting or gasping for air) you will need to perform CPR.
5. C=CPR consists of 2 techniques – 30 chest compressions and 2 breaths of mouth-to-mouth.

Chest compression steps

1. Lie your baby on their back.
2. Place 2 fingers on the lower half of your baby’s breastbone (in the middle of their chest).
3. Press down with your fingers (or palm for babies over 6 months) to about a third of the depth of their chest, then release to the rest position.
4. This counts as one compression.

Note: You may need to use the palm of your hand instead of your fingers depending on the size of your baby.

Mouth-to-mouth on babies (0-12 months)

1. Make sure your baby is resting in the neutral position and that their head and neck is not tilted.
2. Gently lift their chin – be careful not to rest your hands on their throat as this could restrict air getting into their lungs.
3. Take a small breath and cover your baby’s nose and mouth Blow gently for about one second watching for the chest to rise.
4. After each breath watch for your baby’s chest to fall. Place your ear and face close to your baby’s ear and nose to see if air is being expelled.
5. If your baby’s chest is not rising, gently check again for any blockages and remove them.
6. Continue to give 30 chest compressions, followed by 2 breaths (30:2). Aim for 5 sets of 30:2 in about 2 minutes.

Keep going until:

• Your baby recovers (they start to move, breathe normally, cough or cry). Then put them in the recovery position (onto their side).
• The ambulance arrives and the paramedics take over.

Remember, if you are finding it difficult to keep up mouth-to-mouth breathing, keep going with compressions – they can still save your baby’s life.

How to give CPR to young children 1-5 years

This video is also available in the following languages:

• والإنعاش القلبي الرئوي (CPR)للرضّع والأطفال الصغار.
• و  احیای قلبی و ریوی (CPR) برای اطفال و کودکان خوردسن
• و احیای قلبی-ریوی (CPR)ویژه اطفال و خردسالان
• និង ការសង្គ្រោះដង្ហើម និងបេះដូងឱ្យដំណើរការឡើងវិញ (CPR)សម្រាប់កូនក្មេង និងកុមារតូច
• 以及婴幼儿心肺复苏术简介
• ਅਤੇ ਕਾਰਡੀਓਪੁਲਮੋਨਰੀ ਰੀਸੁਸਾਇਟੀਸ਼ਨ (CPR) ਛੋਟੇ ਬਾਲਕਾਂ ਅਤੇ ਬੱਚਿਆਂ ਲਈ
• REANIMACIÓN CARDIOPULMONAR (RCP)PARA NIÑOS PEQUEÑOS
• VÀ HỒI SỨC TIM PHỔI (CPR) CHO TRẺ MỚI BIẾT ĐI VÀ TRẺ NHỎ

Aim for 5 sets of 30 chest compressions to 2 breaths in about 2 minutes.

To perform CPR on children (1-5 years):

1. A=Airways – check your baby’s airways (nose, mouth and throat) are clear. Remove any blockage (such as vomit, blood, food or loose teeth).
2. Make sure your child is in a neutral position (such as on their back). Gently tilt their head back and lift their chin.
3. B=Breathing – is your child breathing normally? If so, gently roll them onto their side (known as the recovery position).
4. If they are not breathing or breathing abnormally (such as grunting or gasping for air) you will need to perform CPR.
5. C=CPR consists of 2 techniques – 30 chest compressions and 2 breaths of mouth-to-mouth.

Chest compression steps

1. Lie your child on their back. Kneel beside them.
2. Place the heel of one hand on the lower half of your child’s breastbone (in the middle of their chest).
3. Position yourself above your child’s chest.
4. Keep your arm straight and press down on their chest to a third in depth, then release the pressure.

This counts as one compression.

Mouth-to-mouth on children (1-5 years)

1. Open your child’s airway by gently placing one hand on their forehead and the other hand on their chin to tilt their head back.
2. Pinch the soft part of their nose closed with your index finger and thumb.
3. With your other hand, open their mouth with your thumbs and fingers.
4. Take a breath and place your lips over your child’s mouth. Ensure you have a good seal so no air can escape.
5. Blow steadily for about one second, watching for the chest to rise.
6. After each breath watch for their chest to fall. Listen and feel for signs that air is being expelled.
7. Maintain the chin lift and tilt position – take another breath and repeat.
8. If your child’s chest is not rising, check again for any blockages and remove them. Then keep going with mouth-to mouth, making sure their head is lifted, chin tilted. Ensure that no air is escaping.
9. Continue to give 30 chest compressions, followed by 2 breaths (30:2). Aim for 5 sets of 30:2 in about 2 minutes.

Keep going until:

• Your child recovers (they start to move, breathe normally, cough or talk). Then put them in the recovery position (onto their side).
• The ambulance arrives and the paramedics take over.

D= Defibrillator – CPR must be continued until an automated external defibrillator (AED) becomes available, the pads are attached and the machine is turned on.

Remember, if you are finding it difficult to keep up mouth-to-mouth breathing, keep going with compressions – they can still save your child’s life.

How to give CPR to adults and older children

Aim for 5 sets of 30 chest compressions to 2 breaths in about 2 minutes.

If you can’t do mouth-to-mouth, stick with continuous compressions at a rate of approximately 100 per minute.

To perform CPR on adults and older children:

1. A=Airways – open the person’s airways (nose, mouth and throat) and check they are clear. Remove any blockage (such as vomit, blood, food or loose teeth). Don’t spend too much time doing this – CPR is your main priority.
2. Make sure the person is in a neutral position (such as on their back). Gently tilt their head back and lift their chin.
3. B=Breathing – are they breathing normally? If so, gently roll them onto their side (known as the recovery position).
4. If they are not breathing or breathing abnormally (such as grunting or gasping for air) you will need to give them CPR.
5. C=CPR consists of 2 techniques – 30 chest compressions and 2 breaths of mouth-to-mouth.

Chest compression steps

Place the heel of one hand on the lower half of the person’s breastbone (in the middle of their chest).

1. Place your other hand on top of your bottom hand and grasp your wrist. Or you may like to interlock your fingers – depending on what feels comfortable.
2. Keep your arms straight and press down on their chest by one third of their chest depth.
3. Release the pressure – this counts as one compression.

Popular tunes can help keep the rhythm of compressions

To keep the correct rhythm of compressions, you may like to use these popular songs:

• ‘Staying alive’ by the Bee Gees
• ‘Row, row, row, your boat’
• ‘Baby shark’.

Mouth-to-mouth on adults and older children

1. If the person is not breathing normally, make sure they are lying on their back on a firm surface.
2. Open the airway by tilting the head back and lifting their chin.
3. Close their nostrils with your finger and thumb.
4. Put your mouth over the person’s mouth and blow into their mouth. Make sure no air is leaking.
5. Give 2 full breaths to the person (this is called ‘rescue breathing’).
6. Check their chest is rising and falling. If this is not happening, tilt their head back, pinch their nostrils tightly and seal your mouth to theirs.
7. If still no luck, check their airway for any obstruction.
8. If you cannot get air into their lungs, go back to chest compressions – this may help shift an obstruction.
9. Continue to give 30 chest compressions, followed by 2 breaths (30:2). Aim for 5 sets of 30:2 in about 2 minutes.

Keep going until:

• The person becomes responsive. They may begin to move, breathe normally, cough or talk. Then put them in the recovery position (onto their side).
• The ambulance arrives and the paramedics take over.

CPR can be tiring. If you need a break, ask someone else to assist with minimal disruption. Rotate the person performing compressions every 2 minutes.

If you find mouth-to-mouth difficult, continue with chest compressions until medical help arrives. They can still save someone’s life.

Can it be dangerous doing chest compressions?

Sometimes, people will have their ribs broken by chest compressions. This is still better than the alternative of not receiving CPR.
If this occurs, pause and reposition your hands before continuing or get someone else to take over.

Automated external defibrillators (AED)

D= Defibrillator – A defibrillator is a life-saving device that treats someone who is having a cardiac arrest. It can analyse abnormal heart rhythms and send an electric shock or pulse to get the heart to return to its normal pumping rhythm.

CPR must be continued until an automated external defibrillator (AED) becomes available. The pads must be attached to the skin and the machine turned on.

AEDs are easy to use – voice prompts tell you what to do.

There are different types of AEDs and some are available in public places (such as shopping centres and schools).

It is important to follow the prompts on the AED. Do not touch the person during analysis or shock delivery.

Consider a first aid course to learn CPR and basic skills

If there is an emergency, knowing simple first aid can mean the difference between life and death. Consider taking a first aid course. CPR can be life-saving first aid – it increases someone’s chances of survival until an ambulance arrives.

First aid training courses are available across Australia. A course typically takes a couple of hours and can be taken online or in person. Times are also flexible.

Participants learn basic first aid skills (including CPR) and usually receive a certificate. Follow up refresher courses are recommended every 3 years.

Many organisations hold regular courses, ask your doctor or maternal and child health nurse for more information.

Where to get help

• In an emergency, call triple zero (000)
• Your local maternal and child health service
• Your GP (doctor)
• Maternal and Child Health Line Tel. 13 22 29 – available 24 hours a day for the cost of a local call throughout Victoria
• Aboriginal Health Service (VAHS) Tel. 03 9419 3000
• Parentline Tel. 13 22 89
• Translating and Interpreting Service (TIS National) Tel. 131 450 – available (24 hours, 7 days a week) for callers who speak other languages
• National Relay Service (24 hours a day, every day) – Speak and listen Tel: 1300 555 727, TTY Tel: 133 677, SMS relay Tel: 0423 677 767. Captioned, internet and video relay calls are also available through this service.
• NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health advice 24 hours a day, 7 days a week
• Ambulance Victoria Tel. 1800 64 84 84 (purchase ambulance cover) (Mon-Fri 8am - 8pm & Sat 9am - 5pm) Tel. 1300 366 141 (membership queries) (Mon-Fri 8am - 8pm & Sat 9am - 5pm)
• St John Ambulance Australia (first aid courses) Victoria Tel. 1300 360 455
• Australian Red Cross (first aid and mental health training) Tel. 1800 733 276