What is CPR? What Does CPR Stand For?
CPR stands for Cardiopulmonary Resuscitation — a life-saving emergency technique used when the heart stops beating suddenly (Sudden Cardiac Arrest — SCA) or when breathing stops.
CPR has two main components:
- Cardio (heart) — Chest compressions to pump blood to the brain and vital organs
- Pulmonary (lungs) — Rescue breathing to deliver oxygen to the lungs
Why CPR matters:
When the heart stops, the brain begins losing oxygen within 4 minutes and sustains permanent damage within 6-10 minutes (AHA, 2020). CPR maintains approximately 25-30% of normal blood flow to the brain — enough to "buy time" until an AED or EMS team arrives.
CPR alone vs CPR + AED:
- CPR alone: 5-10% survival rate
- CPR + AED within 3-5 minutes: 50-70% survival rate (AHA, 2020)
This is why this guide teaches both CPR and AED use together.
The C-A-B sequence (AHA standard since 2010):
The current standard is C-A-B, not the older A-B-C:
1. C — Compression (chest compressions first)
2. A — Airway (open the airway)
3. B — Breathing (rescue breaths)
Rationale: Immediate chest compressions matter more than rescue breathing because blood still contains oxygen in the first minutes. Pumping that oxygenated blood to the brain is the first priority.
How to Perform CPR on Adults — Detailed Steps
Adult chest compression specs (age 12+):
- Depth: 5-6 centimeters (no less than 5 cm, no more than 6 cm)
- Rate: 100-120 compressions per minute
- Ratio: 30 compressions : 2 rescue breaths (30:2)
- Position: center of chest, nipple line
- Technique: heel of hand stacked, arms straight
Proper technique:
1. Kneel beside the patient with shoulders directly above your hands
2. Use your body weight to compress, not just arm strength
3. Press deep enough (5-6 cm) — most people compress too shallow
4. Allow full chest recoil between compressions — don't lean on the chest
5. Minimize interruptions (no more than 10 seconds for rescue breaths)
Hands-Only CPR:
Per AHA, for witnessed adult cardiac arrest, untrained rescuers or those uncomfortable with rescue breathing can perform Hands-Only CPR (continuous compressions at 100-120/min, no mouth-to-mouth). This is nearly as effective as 30:2 CPR in the first few minutes.
Easy rhythm tip: Compress to the beat of "Stayin' Alive" by the Bee Gees (103 BPM) — matches the 100-120/min target.
Rotate compressors:
With multiple rescuers, switch every 2 minutes (5 cycles of 30:2). Compression quality declines after 2 minutes even when the compressor doesn't feel tired. Switch quickly (within 5 seconds).
CPR for Children and Infants — Key Differences
CPR for children and infants follows the same principles as adults but adjusts force and technique for body size.
| Criteria | Adult (12+) | Child (1-12) | Infant (< 1) |
|----------|------------|-------------|--------------|
| Depth | 5-6 cm | ~5 cm (1/3 chest) | ~4 cm (1/3 chest) |
| Rate | 100-120/min | 100-120/min | 100-120/min |
| Ratio (1 rescuer) | 30:2 | 30:2 | 30:2 |
| Ratio (2 rescuers) | 30:2 | 15:2 | 15:2 |
| Technique | 2 hands stacked | 1 or 2 hands | Heel of 1 hand / Two-Thumb |
| Hands-Only | Yes | Not recommended | Not recommended |
Child CPR (age 1-12):
- Depth: approximately 5 cm (or 1/3 of chest depth)
- Rate: 100-120 compressions/min
- Ratio: 30:2 (1 rescuer) or 15:2 (2 rescuers)
- Technique: heel of one hand (small child) or two hands stacked (larger child)
- Key point: Pediatric cardiac arrest is usually caused by airway/breathing problems (not cardiac like adults), so rescue breaths are essential — do not use Hands-Only CPR for children
Infant CPR (under 1 year):
- Depth: approximately 4 cm (or 1/3 of chest depth)
- Rate: 100-120 compressions/min
- Ratio: 30:2 (1 rescuer) or 15:2 (2 rescuers)
- Technique (AHA 2025 update):
- Two-Thumb Encircling Hands: Place both thumbs on the breastbone, hands encircling the torso — recommended with 2 rescuers
- Heel of One Hand: AHA 2025 now permits using the heel of one hand instead of the older two-finger technique for more consistent compressions
- Never use the two-handed adult technique — too much force for an infant
- Position: center of chest, just below the nipple line
Infant rescue breathing:
- Cover the infant's mouth AND nose simultaneously (unlike adults)
- Blow gently — just enough to see the chest rise
- Avoid blowing too forcefully — may cause stomach distension or lung injury
Chain of Survival
According to the American Heart Association (AHA, 2020), survival from cardiac arrest depends on the "Chain of Survival." Every link must connect — a break in any link reduces survival immediately.
Link 1: Early Recognition & Call
Recognize symptoms: unconsciousness, no breathing, or gasping → Call 1669 immediately
- Average EMS response in Bangkok: 8-12 minutes
- Rural areas: 15-20+ minutes
- Both exceed the golden window (3-5 minutes)
Link 2: Early CPR
Start chest compressions immediately after calling 1669 — don't wait for EMS
- CPR maintains 25-30% of normal blood flow
- Enough to prevent permanent brain damage
Link 3: Early Defibrillation
Use an AED as soon as one is available — it's the only thing that corrects Ventricular Fibrillation (VF)
- CPR alone cannot reset an abnormal heart rhythm
- Only an AED's electrical shock can "reset" the heart
- Read the full AED usage guide: What is an AED?
Link 4: Advanced Care
EMS teams and hospitals provide IV medications, intubation, and advanced treatments
Link 5: Post-Cardiac Arrest Care
ICU care to prevent recurrence and support brain recovery
Links 2 and 3 are what bystanders can do — and they make the biggest difference.
CPR and AED — Why You Need Both
Many people mistakenly believe CPR can "restart the heart." In reality, CPR cannot restore a stopped heart to normal rhythm — it only "pumps blood in place of the heart" temporarily.
Role of CPR:
- Pumps blood to the brain (25-30% of normal flow)
- Prevents permanent brain damage
- "Buys time" until AED arrives
- Keeps the heart in a state where AED shock can be effective
Role of AED:
- Analyzes heart rhythm — checks for VF or VT requiring shock
- Delivers electrical "reset" — the only treatment for VF
- Prevents unnecessary shocks — safe for non-medical users
Why CPR before AED:
In many situations, the nearest AED must be retrieved. During this time, CPR must not stop. If compressions stop, blood stops flowing to the brain and brain cells begin dying immediately.
Correct sequence:
1. Call 1669 + send someone to get AED
2. Start CPR immediately (don't wait for AED)
3. When AED arrives → power on, apply pads, follow prompts
4. After shock (or no shock advised) → resume CPR
5. Alternate until EMS arrives
Modern AEDs like the Amoul i-Series include CPR coaching — voice prompts guiding compression rhythm and depth during CPR for more effective bystander response.
Read more: AED Brand Comparison | Cardiac Arrest Emergency Guide
When to Stop CPR
A common question: "How long do I keep doing CPR?" The answer:
Stop CPR when:
1. Patient recovers — starts breathing, moves, or responds → place in recovery position, wait for EMS
2. EMS arrives — hand over to the medical team, report CPR start time and cycle count
3. AED instructs you to stop — pause briefly while the AED analyzes heart rhythm
4. Scene becomes unsafe — building fire, gas leak, flooding → move the patient first
5. You are truly exhausted — if no one can rotate and your compressions are too shallow (below 5 cm), ineffective CPR equals no CPR
Do NOT stop because:
- You're afraid of doing it wrong — imperfect CPR is far better than none
- You fear legal liability — the Emergency Medical Act protects good-faith rescuers
- You feel ribs crack — rib fractures are common and treatable; brain oxygen deprivation may not be
- The patient hasn't woken up — CPR must continue; patients have recovered after 30+ minutes of CPR
Legal Protection for CPR Rescuers in Thailand
Emergency Medical Act B.E. 2551 (2008) — Thailand's Good Samaritan Law
Section 29 protects individuals who provide emergency assistance in good faith. Non-medical personnel who perform CPR or use an AED are protected from civil and criminal liability, as long as they act in good faith to save a life.
What everyone in Thailand should know:
- You don't need to be a doctor or nurse to perform CPR
- You don't need formal training to perform CPR (though training is recommended for confidence)
- AEDs will not shock a normally beating heart — you cannot harm someone by using an AED
- Not helping ≠ safer — patients who don't receive CPR have extremely high mortality
Where to learn CPR in Thailand:
- Thai Red Cross — public CPR courses
- National Institute for Emergency Medicine (NIEM/สพฉ.)
- Various hospitals offer periodic CPR training
- Organizations can arrange on-site training with certified instructors
Read more about AED law: Thai AED Law — Ministerial Regulation No. 69
Frequently Asked Questions
What does CPR stand for?
CPR stands for Cardiopulmonary Resuscitation — a life-saving technique combining chest compressions and rescue breathing to maintain blood flow to the brain during cardiac arrest.
How deep should CPR compressions be? How many compressions?
Adults: 5-6 cm deep, 100-120 compressions/min, 30:2 ratio. Children: ~5 cm. Infants: ~4 cm (1/3 of chest depth). All age groups use 100-120 compressions/min.
Can I do CPR without mouth-to-mouth?
Yes, for adults AHA recommends Hands-Only CPR (continuous compressions at 100-120/min, no mouth-to-mouth) for untrained rescuers. It's nearly as effective as 30:2 CPR in the first minutes. But children and infants always need rescue breaths.
Can anyone perform CPR? Is it legal?
Yes, it's legal. Thailand's Emergency Medical Act B.E. 2551 protects good-faith rescuers. No training is required. Imperfect CPR is far better than no CPR. Training is recommended for confidence.
What are the 7 steps of CPR?
1) Check safety and responsiveness 2) Call 1669 and request AED 3) Position patient and place hands 4) 30 chest compressions (5-6cm deep, 100-120/min) 5) 2 rescue breaths 6) Use AED when available 7) Continue CPR until EMS arrives.
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