How are chest compressions administered during cardiopulmonary resuscitation (CPR)?

Answer

The provider should do the following:

Place the heel of one hand on the patient’s sternum and the other hand on top of the first, fingers interlaced
Extend the elbows and the provider leans directly over the patient (see the image below)
Press down, compressing the chest at least 2 in
Release the chest and allow it to recoil completely
The compression depth for adults should be at least 2 inches (instead of up to 2 inches, as in the past)
The compression rate should be at least 100/min
The key phrase for chest compression is, “Push hard and fast”
Untrained bystanders should perform chest compression–only CPR (COCPR)
After 30 compressions, 2 breaths are given; however, an intubated patient should receive continuous compressions while ventilations are given 8-10 times per minute
This entire process is repeated until a pulse returns or the patient is transferred to definitive care
To prevent provider fatigue or injury, new providers should intervene every 2-3 minutes (ie, providers should swap out, giving the chest compressor a rest while another rescuer continues CPR

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Media Gallery

Delivery of chest compressions. Note the overlapping hands placed on the center of the sternum, with the rescuer's arms extended. Chest compressions are to be delivered at a rate of at least 100 compressions per minute.
Delivery of mouth-to-mouth ventilations.
CPR positioning. Video courtesy of Daniel Herzberg, 2008.
CPR ventilation. Video courtesy of Daniel Herzberg, 2008.
CPR compressions. Video courtesy of Daniel Herzberg, 2008.

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Author

Catharine A Bon, MD Assistant Clinical Instructor, Resident Physician, Department of Emergency Medicine, State University of New York Downstate Medical Center, Kings County Hospital Center

Disclosure: Nothing to disclose.

Coauthor(s)

Baruch Berzon, MD Resident Physician, Departments of Emergency Medicine and Internal Medicine, State University of New York Downstate Medical Center, Kings County Hospital Center

Disclosure: Nothing to disclose.

Joshua Schechter, MD Clinical Assistant Professor, Director of Emergency Ultrasound Resident Education, Kings County Hospital Center, State University of New York Downstate Medical Center

Joshua Schechter, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Ali A Sovari, MD, FACP, FACC Attending Physician, Cardiac Electrophysiologist, Cedars Sinai Medical Center and St John's Regional Medical Center

Ali A Sovari, MD, FACP, FACC is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Physician Scientists Association, American Physiological Society, Biophysical Society, Heart Rhythm Society, Society for Cardiovascular Magnetic Resonance

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Kirsten A Bechtel, MD Associate Professor of Pediatrics, Section of Pediatric Emergency Medicine, Yale University School of Medicine; Co-Director, Injury Free Coalition for Kids, Yale-New Haven Children's Hospital

Kirsten A Bechtel, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Additional Contributors

Andrew K Chang, MD, MS Vincent P Verdile, MD, Endowed Chair in Emergency Medicine, Professor of Emergency Medicine, Vice Chair of Research and Academic Affairs, Albany Medical College; Associate Professor of Clinical Emergency Medicine, Albert Einstein College of Medicine; Attending Physician, Department of Emergency Medicine, Montefiore Medical Center

Andrew K Chang, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American Academy of Pain Medicine, American College of Emergency Physicians, American Geriatrics Society, American Pain Society, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Benjamin S Abella, MD, MPH Assistant Professor, Department of Emergency Medicine, Clinical Research Director, Center for Resuscitation Science, Co-Chair, Hospital Code Committee, University of Pennsylvania School of Medicine

Benjamin S Abella, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Heart Association, Phi Beta Kappa, Sigma Xi, and Society for Academic Emergency Medicine

Disclosure: Philips Healthcare, Grant/research funds, Other; Philips Healthcare, Honoraria, Speaking and teaching; Medivance Corporation, Honoraria, Speaking and teaching; Doris Duke Foundation, Grant/research funds, Other; American Heart Association, Grant/research funds, Other; Laerdal, Grant/research funds, Other

Alena Lira, MD Resident Physician, Departments of Emergency Medicine and Internal Medicine, Kings County Hospital Center, State University of New York Downstate Medical Center

Disclosure: Nothing to disclose.

Richard H Sinert, DO Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Noah T Sugerman, EMT Clinical Research Assistant, Center for Resuscitation Science, Department of Emergency Medicine, Hospital of the University of Pennsylvania; Emergency Medical Technician, Narberth Ambulance

Disclosure: Nothing to disclose.

Acknowledgments

Special thanks to Matthew Jones for appearing in the video demonstrations.

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