Basic Life Support for Healthcare Providers
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Article at a Glance
- High-quality cardiopulmonary resuscitation (CPR) is the cornerstone of both basic life support (BLS) and advanced cardiac life support (ACLS).
- Clinicians must practice frequently to be able to provide chest compressions at the correct rate and depth.
- Minimizing interruptions in chest compressions is an important concept in high-quality CPR.
- For pulseless rhythms, CPR should be given right up until it is time to deliver the shock (manual defibrillator) or analyze the rhythm (automated external defibrillator [AED]).
The updated American Heart Association (AHA) BLS guidelines emphasize providing high-quality CPR. They emphasize the following:
- Reducing time to first chest compressions by performing procedures simultaneously, such as checking for breathing and pulse at the same time and over now more than 10 seconds.
- Choreographing activities of multiple trained rescuers so that essential procedures are performed simultaneously, such as activating the emergency response system and beginning chest compressions and ventilations.
- Creating performance targets to ensure high-quality CPR.
- Adding passive ventilation techniques to the bundles of care for the emergency medical services (EMS) team and hospitals.
High-quality CPR is the cornerstone of BLS and ACLS.
Related Video – CPR Skills Review
Adult BLS Algorithm for Healthcare Providers
Immediate Recognition and Activation of Emergency Response Team
The healthcare clinician is trained to simultaneously check for patient response, breathing, and the presence of a pulse.1 If the patient is in danger or is in cardiac arrest, the healthcare clinician immediately activates the emergency response system and seeks backup help.
Related Video – How to Reach EMS
Emphasis on Chest Compressions
In situations of cardiac arrest or a seriously ill patient, the priority of a lone healthcare provider is 1) activating the emergency response system and 2) providing chest compressions. The sequence in cardiac arrest management follows the CAB (circulation-airway-breathing) sequence.
However, some situations (such as drowning) should follow the ABC (airway-breathing-circulation) sequence. In drowning, the primary cause of cardiac arrest is hypoxic in nature. Therefore, providing oxygen through ventilations is essential.
The clinician must be trained in the proper technique of giving chest compressions and ventilations and must perform them quickly.2
Shock First vs. Chest Compressions First
Defibrillation must be performed for ventricular fibrillation or pulseless ventricular tachycardia (i.e., shockable rhythms) as soon as the AED or defibrillator is available and ready.
High-quality CPR must be initiated while the patient is being prepared for defibrillation and up until the AED issues the command to clear the patient.
The healthcare provider immediately performs five cycles of high-quality CPR (two minutes) after giving the shock, then reevaluates the patient and checks for a pulse.
Related Video – One Quick Question: Should You Choose CPR or Defibrillation?
Chest Compression Rate
The chest compression rate must be between 100 to 120 compressions per minute.
Many instructors advocate that clinicians sing a song in their head while performing chest compressions to keep on target; the songs suggested are “Another One Bites the Dust” and “Stayin’ Alive,” both of which have a beat of about 100 to 120 per minute.
Singing the song “Another One Bites the Dust” can help ensure chest compressions are performed at an adequate rate.
Read: Treating Reversible Causes of Pulseless Electrical Activity and Asystole
Chest Compression Depth
Clinicians must administer chest compressions with a compression depth of 5–6 cm (2–2.4 inches).3 Auditory and tactile feedback mechanisms can enhance the clinician’s muscle memory to maintain the recommended chest compression depth.
Aim for chest compressions between 2–2.4 inches deep.
Related Video – One Quick Question: What is a LUCAS Device?
Minimizing Interruptions in Chest Compression
Chest compression fraction (CCF) is the time that chest compressions are being delivered divided by the total time of resuscitation. A CCF of 60% and higher is recommended.4 Interruptions in chest compressions should only occur for intended care or interventions, such as shocking the patient or checking for a pulse. When the EMS team arrives on the scene, the transition to the EMS responders should be coordinated to prevent interruptions over 10 seconds.
Related Video – CPR for Adults with 2 Rescuers
Ventilation During CPR with an Advanced Airway
Asynchronous bag-mask ventilations can be provided in cardiac arrest when an advanced airway, such as an endotracheal tube, is in place. Asynchronous ventilations are delivered at a rate of one breath every six seconds, or 10 breaths per minute. Without an advanced airway, two breaths are delivered after every set of 30 chest compressions.
Related Video – What are Ventilation Devices?
Delayed Ventilation
Positive-pressure ventilation can be delayed initially if there is inadequate equipment or only one responder. In that case, the responder should provide five cycles of continuous chest compressions (about two minutes). Passive oxygen insufflation can be administered during this time.
Audio or Visual Feedback
Devices that give instant feedback regarding the quality of chest compressions are recommended during high-quality CPR, or at least during CPR training.5 These devices can potentially improve muscle memory so that chest compressions are delivered at the recommended depth and rate.
High-quality CPR is the cornerstone of BLS and ACLS. Healthcare providers must understand the correct form and practice frequently to provide chest compressions at the correct rate and depth.
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Editorial Sources
ACLS Certification Association (ACA) uses only high-quality medical resources and peer-reviewed studies to support the facts within our articles. Explore our editorial process to learn how our content reflects clinical accuracy and the latest best practices in medicine. As an ACA Authorized Training Center, all content is reviewed for medical accuracy by the ACA Medical Review Board.
1. Jesse Borke, MD, FACEP, FAAEM; Chief Editor: Kirsten A Bechtel, MD. Cardiopulmonary Resuscitation (CPR). MedScape. 2021.
2. Mayo Clinic. Cardiopulmonary resuscitation (CPR): First aid. 2022.
3. American Heart Association. What is CPR?
4. Deo Mathew, S. Vimal Krishnan,1 Siju V. Abraham, Salish Varghese, Minu Rose Thomas,2 and Babu Urumese Palatty. Chest Compression Fraction and Factors influencing it. Journal of Emergencies, Trauma, and Shock. 2022.
5. Yeongtak Song, MSc, Jaehoon Oh, MD, and Youngjoon Chee, PhD. A New Chest Compression Depth Feedback Algorithm for High-Quality CPR Based on Smartphone. Telemedicine Journal and E-Health. 2015.
More to Learn
Learn the 6 steps of BLS Assessment through the Systematic Approach to a Seriously Ill Patient. Read our detailed article on the mnemonic DRS. ABCD with video illustration.
Keep your life-saving skills current with the 2019 AHA focused update on advanced cardiovascular life support. Learn how to use advanced airways, vasopressors, and extracorporeal cardiopulmonary resuscitation during cardiac arrest.