CPR - adult and child after onset of puberty

CPR is best done by someone trained in an accredited CPR course. The procedures described here are not a substitute for CPR training. The newest techniques emphasize compression over rescue breathing and airway management, reversing a long-standing practice. See cpr.heart.org/en/course-catalog-search for classes near you.

Time is very important when an unconscious person is not breathing. Permanent brain damage begins after only 4 minutes without oxygen, and death can occur as soon as 4 to 6 minutes later.

Machines called automated external defibrillators (AEDs) can be found in many public places, and are available for home use. These machines have pads or paddles to place on the chest during a life-threatening emergency. They automatically check the heart rhythm and give a sudden shock if, and only if, that shock is needed to get the heart back into the right rhythm. When using an AED, follow the instructions exactly.

In adults, major reasons that heartbeat and breathing stop include:

• Drug overdose
• Excessive bleeding
• Heart problem (heart attack or abnormal heart rhythm, fluid in the lungs or compressing the heart)
• Infection in the bloodstream (sepsis)
• Injuries and accidents
• Drowning
• Stroke

CPR should be done if a person has any of the following symptoms:

• No breathing or difficulty breathing (gasping)
• No pulse
• Unconsciousness

1. Check for responsiveness. Shake or tap the person gently. See if the person moves or makes a noise. Shout, "Are you OK?"

2. If there is no response, Call 911 or the local emergency number. Shout for help and send someone to call 911 or the local emergency number. If you are alone, call 911 or the local emergency number. If you know that an AED is available nearby, retrieve the AED even if you have to leave the person. Do not leave the person to look for an AED if you do not know there is one nearby.

3. Carefully place the person on their back. Place the person on a firm, flat surface, if possible. If there is a chance the person has a spinal injury, two people should move the person to prevent the head and neck from twisting.

4. Give 30 chest compressions followed by 2 breaths:

• Stand or kneel beside the person.
• Place the heel of one hand in the center of the person’s chest -- right between the nipples.
• Place the other hand on top of it with fingers interlaced.
• Position your body directly over your hands with your elbows locked and your shoulders in line with your hands.
• Give 30 chest compressions. Press down about 2 inches (5 centimeters) into the chest. Let the chest rise completely after each compression. These compressions should be fast and hard with no pausing. Count the 30 compressions quickly: "1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30, off".

5. Open the airway. Lift up the chin with 2 fingers. At the same time, tilt the head by firmly pushing the forehead back with the other hand.

6. Look, listen, and feel for breathing. Place your ear close to the person's mouth and nose. Watch for chest movement. Feel for breath on your cheek.

7. If the person is not breathing or has trouble breathing:

• Cover their mouth tightly with your mouth.
• Pinch the nose closed.
• Keep the chin lifted and head tilted.
• Give 2 rescue breaths. Each breath should take about a second and make the chest rise. Allow the air to exit after each breath.

8. Repeat cycles of 30 chest compressions and 2 rescue breaths until the person recovers or help arrives.

• Do 100 to 120 compressions per minute. Pauses in chest compressions for rescue breaths should be less than 10 seconds.
• If two or more rescuers are available, then switch compressors every 2 minutes or after about 5 cycles of 30 compressions and 2 breaths to prevent rescuer fatigue.
• If an AED is available, use it as soon as possible.
• If opioid poisoning (overdose of medicines, fentanyl, or heroin) is suspected, and the person is not breathing, give Naloxone if available, without interfering with CPR.

If the person starts breathing again, place them in the recovery position. To do this, start with the person lying on their back. Then, pull the arm closest to you so that it makes a right angle to their body with palm up. Fold their other arm and place it under their cheek closest to you. You'll have to hold it there. With your free hand, bend the person's right knee that's farthest from you to a right angle. Carefully roll the person onto their left side by pulling on the bent knee toward you. Their bent arm should be supporting the head, and their extended arm will stop you from rolling them too far. Make sure their bent leg is at a right angle. Keep checking for breathing until help arrives.

Avoid making the situation worse by following these tips:

• If you think the person has a spinal injury, pull the jaw forward without moving the head or neck. Do not let the mouth close.
• If the person has normal breathing, coughing, or movement, do not begin chest compressions. Doing so may cause the heart to stop beating.
• Unless you are a health professional, do not check for a pulse. Only a health care professional is properly trained to check for a pulse.

Steps to take if you are with another person or if you are alone:

• If you have help, tell one person to call 911 or the local emergency number while another person begins CPR.
• If you are alone, as soon as you determine that the person is unresponsive, call 911 or the local emergency number immediately. Then begin CPR.

In adults, to avoid injuries and heart problems that can lead to the heart stopping beating:

• Eliminate or reduce risk factors that can lead to heart disease, such as cigarette smoking, high cholesterol, high blood pressure, obesity, and stress.
• Get plenty of exercise.
• See your health care provider regularly.
• Always use seat belts and drive safely.
• Avoid using illegal drugs.

Cardiopulmonary resuscitation - adult; Rescue breathing and chest compressions - adult; Resuscitation - cardiopulmonary - adult; Cardiopulmonary resuscitation - child 9 years and older; Rescue breathing and chest compressions - child 9 years and older; Resuscitation - cardiopulmonary - child 9 years and older

American Heart Association website. Highlights of the 2025 American Heart Association guidelines for CPR and ECC. cpr.heart.org/-/media/CPR-Files/2025-documents-for-cpr-heart-edits-posting/Resuscitation-Science/252500_Hghlghts_2025ECCGuidelines.pdf?sc_lang=en. Accessed February 10, 2026.

Cao D, Arens AM, Chow SL, et al. Part 10: Adult and pediatric special circumstances of resuscitation: 2025 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2025;152(16_suppl_2):S578-S672. PMID: 41122889 pubmed.ncbi.nlm.nih.gov/41122889/.

Joyner BL Jr, Dewan M, Bavare A, et al, eds. Part 6: Pediatric basic life support: 2025 American Heart Association and American Academy of Pediatrics guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2025 Oct 21;152(16_suppl_2):S424-S447. PMID: 41122891 pubmed.ncbi.nlm.nih.gov/41122891/.

Kleinman ME, Buick JE, Huber N, et al. Part 7: Adult basic life support: 2025 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2025;152(16_suppl_2):S448-S478. PMID: 41122888 pubmed.ncbi.nlm.nih.gov/41122888/.

Updated by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.