When someone's blood flow or breathing stops, seconds count. Permanent brain damage or death can happen quickly. If you know how to perform cardiopulmonary resuscitation (CPR), you could save a life. CPR is an emergency procedure for a person whose heart has stopped or is no longer breathing. CPR can maintain circulation and breathing until emergency medical help arrives.

Even if you haven't had training, you can do "hands-only" CPR for a teen or adult whose heart has stopped beating ("hands-only" CPR isn't recommended for children). "Hands-only" CPR uses chest compressions to keep blood circulating until emergency help arrives. If you've had training, you can use chest compressions, clear the airway, and do rescue breathing. Rescue breathing helps get oxygen to the lungs for a person who has stopped breathing. To keep your skills up, you should repeat the training every two years.

The position of the heart in the torso between the vertebrae and sternum (see Figure for the position of the heart within the thorax) allows for individuals to apply an emergency technique known as cardiopulmonary resuscitation (CPR) if the heart of a patient should stop. By applying pressure with the flat portion of one hand on the sternum in the area between the line at T4 and T9 (Figure), it is possible to manually compress the blood within the heart enough to push some of the blood within it into the pulmonary and systemic circuits. This is particularly critical for the brain, as irreversible damage and death of neurons occur within minutes of loss of blood flow. Current standards call for compression of the chest at least 5 cm deep and at a rate of 100 compressions per minute, a rate equal to the beat in "Staying Alive," recorded in 1977 by the Bee Gees. If you are unfamiliar with this song, a version is available on www.youtube.com. At this stage, the emphasis is on performing high-quality chest compressions, rather than providing artificial respiration. CPR is generally performed until the patient regains spontaneous contraction or is declared dead by an experienced healthcare professional.

When performed by untrained or overzealous individuals, CPR can result in broken ribs or a broken sternum, and can inflict additional severe damage on the patient. It is also possible, if the hands are placed too low on the sternum, to manually drive the xiphoid process into the liver, a consequence that may prove fatal for the patient. Proper training is essential. This proven life-sustaining technique is so valuable that virtually all medical personnel as well as concerned members of the public should be certified and routinely recertified in its application. CPR courses are offered at a variety of locations, including colleges, hospitals, the American Red Cross, and some commercial companies. They normally include practice of the compression technique on a mannequin.

CPR Technique

If the heart should stop, CPR can maintain the flow of blood until the heart resumes beating. By applying pressure to the sternum, the blood within the heart will be squeezed out of the heart and into the circulation. Proper positioning of the hands on the sternum to perform CPR would be between the lines at T4 and T9.

Position of the Heart in the Thorax

The heart is located within the thoracic cavity, medially between the lungs in the mediastinum. It is about the size of a fist, is broad at the top, and tapers toward the base.

• The person is unresponsive, even if you shake or shout at them.
• The person isn’t breathing or is only gasping.

If you see someone in cardiac arrest, call 9-1-1 right away and then start CPR. Keep doing CPR until medical professionals arrive.

People who have cardiac arrests may benefit from CPR, yet many people who witness cardiac arrest do not perform CPR. Learn about CPR so you can be prepared.

What Is CPR and When Should I Use It?

Cardiopulmonary resuscitation (CPR) is an emergency procedure that can help save a person’s life if their breathing or heart stops. When a person’s heart stops beating, they are in cardiac arrest. During cardiac arrest, the heart cannot pump blood to the rest of the body, including the brain and lungs. Death can happen in minutes without treatment. CPR uses chest compressions to mimic how the heart pumps. These compressions help keep blood flowing throughout the body.

Cardiac arrest is not the same as a heart attack. A heart attack happens when blood flow to the heart is blocked. A person having a heart attack is still talking and breathing. This person does not need CPR—but they do need to get to the hospital right away. Heart attack increases the risk for going into cardiac arrest.

Learn some surprising facts about CPR, cardiac arrest, and how you can be prepared to help save a life.

1. CPR Saves Lives.

Currently, about 9 in 10 people who have cardiac arrest outside the hospital die. But CPR can help improve those odds. If it is performed in the first few minutes of cardiac arrest, CPR can double or triple a person’s chance of survival.

Certain people, including people in low-income, black, and Hispanic neighborhoods, are less likely to receive CPR from bystanders than people in high-income, white neighborhoods.

Women may also be less likely to receive CPR if they experience cardiac arrest in a public place.

2. Cardiac Arrests Often Happen at Home

About 350,000 cardiac arrests happen outside of hospitals each year—and about 7 in 10 of those happen at home. Unfortunately, about half of the people who experience cardiac arrests at home don’t get the help they need from bystanders before an ambulance arrives.

If you see cardiac arrest happen (see sidebar), call 9-1-1 right away and then do CPR until medical professionals arrive. Keep reading to learn how to perform CPR.

3. You Don’t Need Formal Training to Perform CPR.

You don’t need a special certification or formal training to perform CPR, but you do need education. If cardiac arrest happens to someone near you, don’t be afraid—just be prepared! Follow these steps if you see someone in cardiac arrest:

• Call 9-1-1 right away. If another bystander is nearby, save time by asking that person to call 9-1-1 and look for an automated external defibrillator (AED) while you begin CPR. AEDs are portable machines that can electrically shock the heart and cause it to start beating again.
• Give CPR. Push down hard and fast in the center of the chest at a rate of 100 to 120 pushes a minute. Let the chest come back up to its normal position after each push. The American Heart Association (AHA) recommends timing your pushes to the beat of the song “Stayin’ Alive.” This method of CPR is called “hands-only” and does not involve breathing into the person’s mouth.
• Continue giving CPR until medical professionals arrive or until a person with formal CPR training can take over.

If you want to gain confidence in performing CPR, consider taking a class or attending a training.

What is sudden cardiac arrest (SCA)?

Sudden cardiac arrest (SCA) is a condition in which the heart suddenly stops beating. When that happens, blood stops flowing to the brain and other vital organs. If it is not treated, SCA usually causes death within minutes. But quick treatment with a defibrillator may be lifesaving.

How is sudden cardiac arrest (SCA) different from a heart attack?

A heart attack is different from an SCA. A heart attack happens when blood flow to the heart is blocked. During a heart attack, the heart usually doesn't suddenly stop beating. With an SCA, the heart stops beating.

Sometimes an SCA can happen after or during recovery from a heart attack.

What causes sudden cardiac arrest (SCA)?

Your heart has an electrical system that controls the rate and rhythm of your heartbeat. An SCA can happen when the heart's electrical system is not working right and causes irregular heartbeats. Irregular heartbeats are called arrhythmias. There are different types. They may cause the heart to beat too fast, too slow, or with an irregular rhythm. Some can cause the heart to stop pumping blood to the body; this is the type that causes SCA.

Certain diseases and conditions can cause the electrical problems that lead to SCA. They include:

• Ventricular fibrillation, a type of arrhythmia where the ventricles (the heart's lower chambers) don't beat normally. Instead, they beat very fast and very irregularly. They can't pump blood to the body. This causes most SCAs.
• Coronary artery disease (CAD), also called ischemic heart disease. CAD happens when the arteries of the heart cannot deliver enough oxygen-rich blood to the heart. It is often caused by the buildup of plaque, a waxy substance, inside the lining of larger coronary arteries. The plaque blocks some or all of the blood flow to the heart.
• Some types of physical stress can cause your heart's electrical system to fail, such as
  • Intense physical activity in which your body releases the hormone adrenaline. This hormone can trigger SCA in people who have heart problems.
  • Very low blood levels of potassium or magnesium. These minerals play an important role in your heart's electrical system.
  • Major blood loss
  • Severe lack of oxygen
• Certain inherited disorders which can cause arrhythmias or problems with the structure of your heart
• Structural changes in the heart, such as an enlarged heart due to high blood pressure or advanced heart disease. Heart infections can also cause changes to the structure of the heart.

Who is at risk for sudden cardiac arrest (SCA)?

You are at higher risk for SCA if you:

• Have coronary artery disease (CAD). Most people with SCA have CAD. But CAD usually doesn't cause symptoms, so they may not know that they have it.
• Are older; your risk increases with age
• Are a man; it is more common in men than women
• Are Black or African American, especially if you have other conditions such as diabetes, high blood pressure, heart failure, or chronic kidney disease
• Have a personal history of heartbeats that aren't regular (arrhythmia)
• Have a personal or family history of SCA or inherited disorders that can cause arrhythmia
• Have a problem with drug or alcohol use
• Have had a heart attack
• Have heart failure

What are the symptoms of sudden cardiac arrest (SCA)?

Usually, the first sign of SCA is loss of consciousness (fainting). This happens when the heart stops beating.

Some people may have a racing heartbeat or feel dizzy or light-headed just before they faint. And sometimes people have chest pain, shortness of breath, nausea, or vomiting in the hour before they have an SCA.

How is sudden cardiac arrest (SCA) diagnosed?

SCA happens without warning and requires emergency treatment. Health care providers rarely diagnose SCA with medical tests as it's happening. Instead, it is usually diagnosed after it happens. Providers do this by ruling out other causes of a person's sudden collapse.

If you are at high risk for SCA, your provider may refer you to a cardiologist, a doctor who specializes in heart diseases. The cardiologist may ask you to get various heart health tests to see how well you heart is working. He or she will work with you to decide whether you need treatment to prevent SCA.

What are the treatments for sudden cardiac arrest (SCA)?

SCA is an emergency. A person having SCA needs to be treated with a defibrillator right away. A defibrillator is a device sends an electric shock to the heart. The electric shock can restore a normal rhythm to a heart that's stopped beating. To work well, it needs to be done within minutes of the SCA.

Most police officers, emergency medical technicians, and other first responders are trained and equipped to use a defibrillator. Call 9-1-1 right away if someone has signs or symptoms of SCA. The sooner you call for help, the sooner lifesaving treatment can begin.

What should I do if I think that someone has had an SCA?

Many public places such as schools, businesses, and airports have automated external defibrillators (AEDs). AEDs are special defibrillators that untrained people can use if they think that someone has had SCA. AEDS are programmed to give an electric shock if they detect a dangerous arrhythmia. This prevents giving a shock to someone who may have fainted but isn't having SCA.

If you see someone who you think has had SCA, you should give cardiopulmonary resuscitation (CPR) until defibrillation can be done.

People who are at risk for SCA may want to consider having an AED at home. Ask your cardiologist to help you decide whether having an AED in your home might help you.

What are the treatments after surviving sudden cardiac arrest (SCA)?

If you survive SCA, you'll likely be admitted to a hospital for ongoing care and treatment. In the hospital, your medical team will closely watch your heart. They may give you medicines to try to reduce the risk of another SCA.

They will also try to find out what caused your SCA. If you're diagnosed with coronary artery disease, you may have an angioplasty or coronary artery bypass surgery. These procedures help restore blood flow through narrowed or blocked coronary arteries.

Often, people who have had SCA get a device called an implantable cardioverter defibrillator (ICD). This small device is surgically placed under the skin in your chest or abdomen. An ICD uses electric pulses or shocks to help control dangerous arrhythmias.

Can sudden cardiac arrest (SCA) be prevented?

You may be able to lower your risk of SCA by following a heart-healthy lifestyle. If you have coronary artery disease or another heart disease, treating that disease can also lower your risk of SCA. If you have had an SCA, getting an implantable cardioverter defibrillator (ICD) can lower your chance of having another SCA.

Have you noticed an AED device in an airport or other public place? An AED is an automated external defibrillator.

You can use this portable device to quickly shock someone’s heart and try to save their life if they collapse, have no pulse, and stop breathing. This condition is known as sudden cardiac arrest.

If a cardiac arrest isn’t treated within minutes, the person will usually die. When the heart stops beating, blood and oxygen can’t get to the brain. The brain can’t function long without oxygen.

A recent study of people who had cardiac arrest found that bystanders can help save lives if they use an AED while waiting for emergency medical services. Each year, experts estimate, more than 18,000 Americans have a shockable cardiac arrest that occurs in public with witnesses.

If you think someone is having a cardiac arrest, call 911. While you wait for emergency medical services to arrive, you can do CPR (cardiopulmonary resuscitation) and use the AED device.

After you apply two electrode patches to the person’s chest, the AED will check the heart rhythm. If a shock to the heart is needed, the AED will deliver the shock. The shock can restore a normal rhythm.

“We estimate that about 1,700 lives are saved in the United States per year by bystanders using an AED,” says Dr. Myron Weisfeldt of Johns Hopkins University. “Unfortunately, not enough Americans know to look for AEDs in public locations, nor are they trained on how to use them.”

For those who want to learn CPR and how to use an AED, training is easy. You can contact groups like the American Heart Association or the American Red Cross to sign up.

The numbers are staggering. About 350,000 people have a cardiac arrest outside of the hospital each year, and about 9 in 10 of them die.

Bystanders and family members are often first to respond in a medical emergency, but, according to some research, they may hesitate to do cardiopulmonary resuscitation (CPR)—even if they have been trained in CPR and how to use an automated external defibrillator (AED). The most common reasons for responders’ reluctance are mistrust of their abilities and fear of injuring the victim, according to a study in Emergency Medicine Journal.

That was before the coronavirus disease 2019 (COVID-19) outbreak and CDC’s recommendations to keep a physical distance of at least 6 feet from other people and wear a mask in public settings.

Cardiac arrests still happen outside of hospitals during the COVID-19 outbreak, and victims still need help. If you are in the position to save a life, you should.

CPR keeps blood flowing and provides oxygen to the brain and other vital organs, giving the victim a better chance of a full recovery. If performed in the first few minutes of cardiac arrest, it can double or triple a person’s chance of survival.

If you are uncomfortable with putting your mouth on a stranger’s mouth because the other person may have COVID-19, you can do hands-only CPR until help arrives, according to the American Heart Association (AHA).

You don’t need a special certification or formal training to do hands-only CPR. If cardiac arrest happens to someone near you, don’t be afraid to take action:

1. Call 9-1-1 right away. If another bystander is nearby, save time by asking that person to call 9-1-1 and look for an AED while you begin CPR. All 50 states have laws or regulations requiring AEDs in that public gathering places.
2. Give hands-only CPR. Push down hard and fast in the center of the chest at a rate of 100 to 120 compressions or pushes a minute. Let the chest come back up to its normal position after each push. AHA recommends timing your pushes to the beat of the song “Stayin’ Alive.” This method of CPR is called “hands-only” and does not involve breathing into the person’s mouth.
3. Keep giving hands-only CPR until medical professionals arrive or until a person with formal CPR training can take over.

You CAN make a difference, but you must be willing to help.