CPR Chest Compressions: When to Start, When to Stop & the Golden Minutes

High-quality chest compressions are the cornerstone of cardiac arrest survival. The 2020 AHA Guidelines emphasize: Push hard, push fast, minimize interruptions.

When to Start Immediately

• Victim unresponsive (no response to tap/shout).
• Not breathing or only gasping (agonal breaths).
• Do not check pulse (lay rescuers); healthcare providers: ≤10 seconds.
• Call 911 / activate emergency response first (or send someone).

Compression Technique (Adults)

• Rate: 100–120/min.
• Depth: ≥2 inches (5 cm), ≤2.4 inches (6 cm).
• Full recoil: Allow chest to return completely.
• Minimize interruptions: <10 seconds for any pause.
• Ratio: 30:2 (single rescuer); continuous compressions with asynchronous ventilations (advanced airway).

When to Stop Compressions

• AED arrives: Pause for rhythm analysis/shock; resume immediately after.
• EMS takes over: Seamless transition; brief report.
• ROSC (Return of Spontaneous Circulation): Victim breathes normally, moves, has palpable pulse.
• Rescuer exhaustion: Rotate every 2 minutes if possible.
• Physician directs cessation: Futility, DNR confirmed, unsafe scene.
• Obvious death: Decapitation, decomposition, rigor mortis, dependent lividity.

The "Golden 5 Minutes"

• Each minute without CPR → 7–10% ↓ survival.
• Bystander CPR doubles/triples survival.
• Target: First compression <2 min from collapse; first shock <3–5 min for VF/VT.

Special Situations

• Children/Infants: 15:2 ratio (2 rescuers); compress ⅓ chest depth (1.5" infant, 2" child).
• Pregnancy: Manual left uterine displacement; perimortem C-section if >20 weeks, no ROSC at 4 min.
• Drowning: 5 rescue breaths first, then 30:2.
• Opioid overdose: Naloxone + CPR; consider rescue breathing if pulse present.

Compressions buy time for defibrillation and advanced care. Any attempt is better than none.