CPR, How Many Compressions to How Many Breaths?

When talking to people about first aid and CPR in particular, I find a lot of confusion centred around the ratio of compressions to rescue breaths. That is, how many times should you press down on the chest and how many times should you give mouth to mouth breaths. This is really not too surprising, as it has been subject to change over the years.

Hard Times

Confusing changes

I started to learn first aid in the winter of 1971/72, at the tender age of 8. At that time, CPR was not yet in the public consciousness, having been kept largely to the medically qualified. In the 11th edition of the British Red Cross Junior First Aid Manual (1972), artificial respiration, otherwise known as the “kiss of life” and the P (for pulmonary, relating to the lungs) in CPR, was on its own at the beginning of the book. Cardiac (the C in CPR) compression was in an appendix at the end, with a warning that it should be taught only by a Doctor and used only by experienced first aiders. Here, the advice is that should you be attempting resuscitation alone, then you should use a ratio of 15 compressions to 2 breaths. If, however, you have help, then you should give 5 compressions to 1 breath.

In my 1979 book, I am told that the correct ratio is 5 to 1, with or without help, but by the second half of the eighties we are back to 15 to 2 on our own or 5 to 1 with help.

Confusing huh?

So where do we stand today? Well, guess what? You got it; it’s changed again, but with good reason.

Works better under pressure

You see, it was discovered that when you give cardiac compressions, you need to build up pressure in the system for it to be effective. Rather like an old fashioned hand pump for getting water out of a well, the first few pumps produce no apparent result, but if you keep going your hard work will be rewarded with a steady flow of water. If you give up after a few pushes, take a rest and then try again, you will still get no reward until you learn to keep going.

For this reason, the current best advice is that you should give not 5, not 15, but 30 compressions, before stopping to give 2 rescue breaths. You should then continue with this cycle until help arrives.

So, just to be absolutely clear, let’s go through the current recommendations for Cardio-Pulmonary-Resuscitation (CPR):

The right way to save a life

For any situation where a casualty is suspected to be unconscious, we use the nmemonic DR’S ABC.

Danger:

Before approaching any situation, check for danger. Make sure it is safe for you to proceed (you are no use to anyone if you make yourself a casualty), and that there is no further danger to your casualty.

Response:

Speak loudly to the casualty to check for a response. If none try giving them a gentle shake of the shoulder and then, if still no response, pinch an earlobe or rub the middle of their chest with your knuckles. Be careful not to do this too hard, or you may find yourself at the wrong end of a very upset tired person trying to sleep.

Shout:

If you still get no response, shout for help.

Airway:

When a person is unconscious, their muscles become very relaxed and, since your tongue is one big muscle (no sexist comments please!), it will often fall back and block the air passage at the back of the throat. We can open this airway very easily by tilting the head back. We do this by putting one hand on the forehead to push and steady and lifting the chin with the other hand. Sometimes, this alone may be enough to get a person breathing again.

Breathing:

Now you need to find out if your casualty is breathing normally or not. Tilt your head to look down the casualty’s body and put your ear close to their mouth. This way you can hear any sounds of breathing, feel any breath on your ear and see any chest movement. Be careful to keep the head tilted back whilst you do this, to keep their airway open.

Do this for a maximum of ten seconds. During this time, if the casualty is breathing normally, you will hear/feel/see at least two breaths. Anything less is not normal breathing and should be treated as not breathing at all.

Circulation/CPR:

If your casualty is not breathing normally, you can safely assume that their heart is not beating either, so there will be no circulation of blood in the system. You do not need to try to find a pulse, this will only waste time.

If no help has arrived, you need to get some quickly, even if this means leaving the casualty to do it. The sooner the emergency services get to them, the better their chances of survival.

Once you have summoned an ambulance, or made sure someone else is doing it, start CPR without delay. Begin with 30 compressions, then 2 rescue breaths and so on. If you are unable, or unwilling, to give mouth to mouth or mouth to nose rescue breaths, then just keep giving those compressions without interruption.

Just do it!

Do not be embarrassed if you cannot bring yourself to give mouth to mouth. You can help no one if you’re throwing up in the flower beds. But whatever you do, do something. If someone’s heart and breathing has stopped, they are dead.

What further harm can you do? Absolutely none. By doing something, you can only do good.

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