- Ensure the patient is placed on their back and on a firm surface.
- Kneel near the patient in the most comfortable and effective position for the rescuer that allows for provision of effective compressions and breath delivery.
- Visualise the ‘lower half of the sternum’ as you place the heel of one hand at that point while holding your wrist or interlocking fingers with your other hand.
- Perform 30 rhythmic compressions on the lower half of the sternum, compressing one-third of the depth of the patient’s chest at a rate of 100–120 compressions per minute. Make sure you fully release your hands off the patient’s chest to allow blood to flow back into their heart.
- Follow compressions with two rescue breaths – one breath per second. As you deliver the breaths, use your eyes to watch the patient’s chest rise with each rescue breath to check you are not over- or under-inflating. It is important to note that compressions should be re-started after 2 seconds whether the rescue breaths were successfully delivered or not, maintaining a ratio of 30 compressions to 2 rescue breaths (30:2).
- Be aware that once there is normal cardiac output, there is often a time delay to signs of life appearing, and the patient requires ongoing CPR until signs of life become obvious.
Note:
- A lifesaver may be on either side of the patient, and procedures should be practiced from both sides. For the purpose of a coordinated team approach, Lifesaving CPR dictates that the first rescuer (person doing compressions) ideally should be positioned on the patient’s right side, allowing the AED and oxygen providers to work around them with standardised equipment placement.
- A CPR cycle is complete following the delivery of the second rescue breath.
- Aim to swap compression operators at least every 2 minutes if possible, and sooner if compressions become ineffective due to rescuer fatigue, for example, in a prolonged resuscitation.
- Compressions applied too high are ineffective, as they are not compressing the heart between the sternum and spine. If applied too low, compressions may cause regurgitation and/or damage to internal organs.
- It is possible that ribs may fracture while performing compressions. If so, you should check your hand position and continue with CPR. Complications from rib fractures can be managed once the patient is assessed in hospital.
- In team CPR scenarios, the airway operator is performing the rescue breathing and the compression operator is performing the compressions at any given point in time. Refer to the Team CPR section of this module for more information.
- The use of a metronome set at a rate of 110 beats per minute is recommended when performing CPR, to ensure compressions are provided at the correct rate. Performing compressions too fast or too slow has been shown to reduce survival rates. Metronomes are often built into the AED, or you can utilise phone apps, search engine metronomes, or musical metronomes.
- Do not stop to measure or re-measure your hands in order to determine the location point for chest compressions. With each compression, as your hands come off the chest, you are able to re-adjust your hand position if you are not in the correct location on the lower half of the patient’s sternum.