How to Perform CPR: Hands-Only and Mouth-to-Mouth

First, Know When CPR Is Needed

CPR is used when a person is unresponsive and has stopped breathing normally. The most common example is sudden cardiac arrest, but CPR may also be needed after drowning, choking, an overdose, severe injury, electric shock, or suffocation.

Do not confuse a heart attack with cardiac arrest. A person having a heart attack may be awake, talking, sweating, or clutching their chest. They still need urgent medical help, but they do not automatically need CPR. Cardiac arrest is different: the person may suddenly collapse, become unconscious, and stop breathing normally.

Agonal gasps can be confusing. They may sound like snoring, gulping, or irregular gasping. They are not normal breathing. When in doubt, call emergency services and follow the dispatcher’s instructions. It is better to react quickly than to hold a committee meeting in your head while time slips away.

The First Three Actions: Check, Call, and Care

1. Check that the scene is safe

Before rushing in, take one fast look around. Watch for traffic, fire, electricity, water hazards, violence, falling objects, or anything else that could turn one emergency into two. You cannot help effectively if you become injured.

2. Check for responsiveness

Tap the person’s shoulder and shout something simple, such as, “Are you okay?” If there is no response, look for normal breathing for no more than about 10 seconds. Do not spend several minutes trying to find a pulse unless you are trained to do so.

3. Call 911 and get an AED

Call 911 yourself, or point to a specific person and say, “You in the blue shirt, call 911 and bring the AED.” Specific instructions work better than shouting, “Someone call for help!” because crowds are excellent at assuming another person has already done it.

An automated external defibrillator, or AED, is a portable device that checks the heart rhythm and can tell you whether a shock is needed. Many public places have them, including airports, gyms, schools, offices, malls, and sports venues.

How to Perform Hands-Only CPR

Hands-Only CPR is CPR without rescue breaths. It is the recommended immediate response for most bystanders who witness a teen or adult suddenly collapse. It is especially useful when you are not trained in full CPR, are not comfortable giving mouth-to-mouth breaths, or do not have a breathing barrier available.

Step 1: Position the person

Place the person flat on their back on a firm surface. CPR on a soft mattress is like trying to pump a bicycle tire while standing on a trampoline: lots of effort, not much useful force.

Step 2: Place your hands correctly

Kneel beside the person’s chest. Put the heel of one hand in the center of the chest, on the lower half of the breastbone. Place your other hand on top and interlace your fingers. Keep your fingers off the ribs if possible.

Step 3: Push hard and fast

Lock your elbows, position your shoulders directly above your hands, and press straight down. For an average teen or adult, push at least 2 inches deep, but avoid going excessively deep. Aim for 100 to 120 compressions per minute.

A familiar song with a steady beat can help you remember the pace. “Stayin’ Alive” is the classic example, which is both medically useful and proof that disco may yet save civilization.

Step 4: Let the chest rise fully

After each compression, allow the chest to recoil completely. Do not lean on the chest between pushes. The release is not a break; it is part of the job. Full recoil helps the heart refill with blood before the next compression.

Step 5: Keep going

Continue chest compressions until an AED is ready, emergency responders take over, the person clearly starts moving or breathing normally, the scene becomes unsafe, or you are physically unable to continue.

How to Perform CPR With Mouth-to-Mouth Rescue Breaths

Full CPR combines chest compressions with rescue breaths. It is particularly important when the emergency likely began with a breathing problem rather than a sudden heart rhythm problem. Examples include drowning, opioid overdose, choking after the airway has been cleared, suffocation, and many cardiac arrests involving children or infants.

Rescue breaths are most useful when you are trained, willing, and able to give them. If you are not comfortable giving breaths, do not freeze. Start Hands-Only CPR and follow instructions from 911. Compressions now are far better than perfect technique never.

The 30:2 rhythm

For a single rescuer performing adult CPR, use a cycle of 30 chest compressions followed by 2 rescue breaths. Then immediately return to compressions. Keep interruptions as short as possible.

How to give mouth-to-mouth breaths

1. After 30 compressions, open the airway using a head-tilt, chin-lift motion.
2. Place one hand on the forehead and gently tilt the head back.
3. Lift the chin with the fingers of your other hand.
4. Pinch the person’s nose closed.
5. Make a complete seal over the person’s mouth with your mouth.
6. Give one breath lasting about one second, just enough to make the chest visibly rise.
7. Allow the chest to fall, then give a second breath.
8. Immediately return to another set of 30 chest compressions.

Do not blow too hard or too long. Giant breaths are not better breaths. Overinflating the stomach can cause vomiting and make ventilation more difficult. The goal is a gentle, visible chest rise.

If the chest does not rise, reposition the head, try again, and look only for an object you can clearly see in the mouth. Do not perform a blind finger sweep. Fishing around in someone’s throat can push an object farther down, which is the opposite of helpful.

Hands-Only CPR vs. Mouth-to-Mouth: Which One Should You Use?

Use Hands-Only CPR when:

• A teen or adult suddenly collapses in front of you.
• The person is unresponsive and not breathing normally.
• You are not trained in rescue breaths.
• You are unwilling or unable to provide mouth-to-mouth breathing.
• You are waiting for dispatcher instructions or an AED.

Use CPR with rescue breaths when:

• The person is a child or infant.
• The emergency involves drowning, suffocation, or a likely breathing-related cause.
• An opioid overdose is suspected.
• You are trained and confident enough to give breaths.
• A dispatcher tells you to provide rescue breaths.

The simplest rule is this: if an adult or teen suddenly collapses and you are not trained in full CPR, call 911 and begin chest compressions immediately. If oxygen deprivation is likely, rescue breaths become more important, but compressions should still begin without delay.

CPR for Children and Infants: The Important Differences

Children and infants often experience cardiac arrest because of breathing problems, drowning, choking, severe illness, or trauma. That is why CPR with rescue breaths is especially important for younger victims.

For a child

For a child from about age 1 until puberty, place one or two hands in the center of the chest, depending on the child’s size and your strength. Compress the chest about one-third of its depth, roughly 2 inches for many children. Use 30 compressions followed by 2 breaths when you are alone.

For an infant

For an infant younger than 1 year, use two fingers in the center of the chest, just below the nipple line. Compress about one-third of the chest depth, roughly 1.5 inches. Cover both the infant’s mouth and nose with your mouth to give gentle breaths. Use only enough air to make the chest rise.

These details are not a substitute for pediatric CPR training. If you care for children, work in childcare, teach, coach, babysit, or spend time around water, an in-person CPR course is one of the most practical skills you can learn.

How to Use an AED During CPR

An AED is designed for ordinary people to use. It talks to you, gives visual instructions, and analyzes the heart rhythm. Your job is not to outsmart the machine. Your job is to turn it on and follow its prompts.

1. Turn on the AED as soon as it arrives.
2. Expose the person’s chest and dry it if it is very wet.
3. Attach the adhesive pads exactly as shown in the pictures on the pads.
4. Keep everyone from touching the person while the AED analyzes the rhythm.
5. If the AED advises a shock, make sure no one is touching the person and follow the device prompts.
6. Resume CPR immediately after a shock or after the AED says no shock is advised.

Do not wait for an AED before starting CPR. Begin compressions right away. The AED is an important teammate, but it should join the game without causing a long timeout.

Common CPR Mistakes to Avoid

Waiting too long

The biggest mistake is often hesitation. You do not need to diagnose the exact cause of collapse before calling for help and starting CPR.

Stopping compressions too often

Minimize pauses. Stop only when necessary for rescue breaths, AED analysis, shock delivery, or when the person clearly begins to recover.

Pressing too slowly or too lightly

CPR needs firm, rhythmic compressions. Tiny, timid pushes will not circulate enough blood. Think “hard and fast,” with full chest recoil after every push.

Forgetting that gasping is not normal breathing

A person who gasps, groans, or makes irregular snorting sounds may still be in cardiac arrest. Treat abnormal breathing seriously and call 911.

Trying to be too perfect

Emergency care is not a performance review. You may feel shaky, tired, frightened, or unsure. Start anyway. A dispatcher can coach you, an AED can guide you, and emergency responders are on the way.

What CPR Experiences Teach: Five Real-World Lessons

The following are composite emergency and training scenarios. They are not accounts of identifiable individuals, but they reflect common lessons shared by CPR instructors, responders, and bystanders.

Lesson 1: The hardest part is often starting

Imagine a busy grocery store. A man collapses near the checkout lanes. Several people notice, but for a few seconds nobody moves. One shopper assumes he fainted. Another thinks someone else has called for help. A cashier freezes because she has never seen a person collapse before.

Then one bystander kneels down, checks for a response, and says loudly, “Call 911. Bring the AED.” The moment becomes more organized. Someone contacts emergency services. Someone else finds the AED. The bystander starts compressions.

The lesson is not that this person had perfect technique. The lesson is that action creates action. Once one person takes charge, other people often become useful immediately. In emergencies, a clear voice can be almost as valuable as a steady pair of hands.

Lesson 2: The person may not look like the movies

TV dramas have trained many people to expect dramatic chest clutching, a perfectly timed collapse, and a room full of attractive doctors. Real emergencies can look messier. A person may slump in a chair, fall quietly, make strange gasping sounds, or appear to be sleeping.

That is why checking responsiveness and breathing matters. Someone who is unresponsive and not breathing normally needs immediate attention, even if the situation does not look cinematic. CPR is not reserved for scenes with dramatic music.

Lesson 3: Rescue breaths can matter when oxygen is the problem

Consider a poolside emergency. A child is pulled from the water and is not breathing normally. In this type of situation, oxygen deprivation may have caused the collapse. Chest compressions are still essential, but rescue breaths are particularly important because the emergency began as a breathing problem.

People who have completed CPR training often describe how different a water-related emergency feels from a sudden adult collapse. It reinforces why parents, lifeguards, coaches, babysitters, and anyone who spends time around water should learn full CPR instead of relying only on a video.

Lesson 4: Dispatchers are calm on purpose

Many bystanders remember the 911 dispatcher’s voice more clearly than anything else. The dispatcher may ask direct questions, tell you where to place your hands, count compressions, or remind you not to stop. That calm guidance is not cold or robotic. It is designed to help you focus when your own thoughts are racing.

Put your phone on speaker whenever possible. You can listen, compress, and communicate without trying to hold a phone between your ear and shoulder like a stressed-out office worker from 1997.

Lesson 5: The emotional impact can continue afterward

Helping during CPR can be intense, even when you did everything right. Bystanders may replay the event, feel shaky, cry, feel numb, or wonder whether they should have done something differently. Those reactions are common.

After the emergency, talk with a trusted person, a supervisor, a counselor, or a medical professional if you are struggling. CPR is a physical skill, but responding to a medical crisis is also an emotional experience. Taking care of yourself afterward does not make you weak. It makes you human.

Final Thoughts: The Best CPR Is CPR That Starts

Knowing how to perform CPR can turn panic into a plan. For a suddenly collapsed teen or adult, call 911, get an AED, and begin Hands-Only CPR with hard, fast chest compressions. For children, infants, drowning victims, and other breathing-related emergencies, CPR with rescue breaths may be especially important.

Take a certified CPR and AED class when you can. Practice matters. But remember this in a real emergency: do not wait for confidence to arrive wearing a name tag. Call for help, begin care, and let emergency professionals take it from there.

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