Understanding the Relationship Between CPR and AED
Cardiopulmonary Resuscitation (CPR) is an emergency lifesaving technique that maintains blood circulation through manual chest compressions and assisted ventilation when the heart stops beating. The Automated External Defibrillator (AED), on the other hand, is a device that detects abnormal heart rhythms and delivers shocks to restore normal cardiac function.
The two are inseparable in cardiac arrest emergencies: CPR provides temporary support for vital signs to buy time for AED intervention, while AED rapidly corrects arrhythmias, significantly improving survival rates.
CPR: Buying Time
CPR is an urgent procedure that simulates heart and lung function through chest compressions and rescue breaths to maintain blood flow and oxygen supply until professional medical help arrives, offering a critical window of survival for cardiac arrest victims.
AED: Restarting the Heart
An AED is a portable device that automatically detects abnormal heart rhythms and delivers shocks to help restore normal heartbeats, effectively restarting a stopped heart during emergencies.
When to Use AED or CPR
Begin CPR and use an AED if the patient exhibits the following:
· Sudden collapse – a strong indicator of cardiac arrest, requiring immediate action. Check scene safety and approach the victim quickly.
· No response when spoken to or shaken – indicates loss of consciousness and critical condition, triggering emergency response.
· No breathing or only gasping – irregular, labored gasping (agonal respiration) is a key sign of cardiac arrest and requires urgent intervention.
When to Use an AED
Cardiac Arrest Without Pulse
If the victim is unresponsive, not breathing (or only gasping), and has no effective pulse, call emergency services immediately. Begin CPR and retrieve and use an AED as soon as possible.
After Starting CPR
Once the AED is available, power it on immediately, follow the voice prompts, and attach the electrode pads to the patient’s bare chest. During rhythm analysis and when shock is advised, ensure no one is touching the patient before delivering the shock.
When to Perform CPR
Cardiac Arrest
Upon finding a victim who is unresponsive and not breathing normally, perform high-quality chest compressions and rescue breaths immediately to provide artificial circulation and oxygenation.
Before AED Arrival
While waiting for the AED or preparing it for use, uninterrupted, effective CPR is critical. It supports the brain and heart with oxygen and blood flow, greatly enhancing the success of defibrillation and survival chances. Do not stop.
If No AED Is Available
Continue performing effective CPR without interruption, supplying blood and oxygen to the brain and heart until spontaneous circulation returns or trained rescuers arrive.
How to Use CPR and AED Together: Step-by-Step Guide
1. Ensure Scene Safety
Before approaching the victim, make sure the environment is safe for both the rescuer and the victim. Remove hazards or move the victim to a safer location if needed.
2. Check Responsiveness
Tap the victim’s shoulders and shout loudly near their ears, “Are you okay?” Observe for eye movement, verbal response, or limb motion.
3. Call Emergency Services
If unresponsive, shout for help and instruct someone specifically to call local emergency services. Clearly report the location, victim’s condition, and that CPR has begun. Be prepared to provide further updates.
4. Open the Airway
Place the victim flat on a firm surface. Use the “head-tilt, chin-lift” technique: one hand on the forehead tilting the head back, the other lifting the chin to open the airway.
5. Check Breathing
Position your face close to the victim’s mouth and nose. Listen for breath, watch for chest movement, and feel airflow for at least 5 but no more than 10 seconds. Detect normal breathing or differentiate from agonal gasping.
6. Begin CPR
· Chest Compressions: Place the heel of one hand on the center of the chest (lower half of the sternum between the nipples), with the other hand on top, fingers interlaced. Keep elbows straight and press hard and fast.
· Rescue Breaths: After 30 compressions (rate of 100–120/min, depth at least 5–6 cm in adults, 1/3 of chest depth in children), maintain an open airway, pinch the nose, and seal your mouth over theirs. Give a breath lasting 1 second, watching for chest rise. Give a second breath.
· Do Not Stop: Continue cycles of 30 compressions and 2 breaths. Switch rescuers if needed to maintain quality.
7. Use the AED As Soon As It Arrives
· Turn on the AED and follow its voice and visual instructions precisely.
· Apply Pads to Dry, Bare Skin:
o Adults and Children ≥8 Years Old: One pad below the right collarbone, the other on the lower left side of the chest, mid-axillary line.
o Children Aged 1–8 Years: Use pediatric mode/pads if available. If not, use adult mode/pads. One pad in the center of the chest, the other on the back below the left shoulder blade.
o Infants (<1 Year): Use pediatric mode/manual defibrillator if possible. If unavailable, adult mode/pads may be used cautiously. One pad in the center of the chest slightly to the right of the sternum, the other on the back below the left shoulder blade.
· Do Not Touch the Victim During Analysis. When prompted (“Analyzing heart rhythm”), ensure no contact with the victim.
· If Shock Advised: Ensure everyone is clear and press the shock button immediately.
· If No Shock Advised: Resume CPR with chest compressions immediately.
8. Continue CPR and Follow AED Prompts
· After the shock or if no shock is advised:
o Resume CPR with chest compressions immediately. Do not check pulse or breathing before restarting compressions (the device will re-analyze in approximately 2 minutes).
· Never stop CPR except when instructed by the AED to pause for analysis or shock preparation, which should be kept brief.
· Cycle Repetition: Continue alternating approximately 2-minute cycles of CPR and AED rhythm analysis/shock, always following AED instructions, until professionals take over or the patient regains consciousness and breathes normally.
CPR First or AED First? What You Need to Know
Starting CPR Immediately Is Critical
Do not wait passively for the AED to arrive. Once unresponsiveness and lack of normal breathing (or agonal breathing) are confirmed, begin CPR without delay. Every second counts.
Using an AED Is Safe and Reliable
Modern AEDs are highly intelligent with clear voice and visual prompts. The device only advises shock when a shockable rhythm is detected. The rescuer doesn’t need to diagnose—just follow instructions. Do not fear using it.
Continuous CPR Is the Core Principle
Unless the AED clearly instructs “Do not touch the patient” or “Analyzing rhythm,” or professionals take over, do not stop CPR. Interruptions longer than 10 seconds can severely reduce perfusion and survival chances.
Proper Pad Attachment Is Essential
The AED’s effectiveness depends on proper pad-to-skin contact. Remove or cut away clothing, thoroughly dry chest sweat or moisture, and apply pads firmly to clean, dry, bare skin. Press edges to ensure full adhesion.
Frequently Asked Questions About CPR and AED
Q: If Shock Is Not Advised, Should I Keep the Pads On?
A: Yes. Keep the electrode pads attached. The AED continuously monitors the heart and will reanalyze rhythm every 2 minutes. Pause contact only during analysis, and resume chest compressions when prompted.
Q: Do All Workplaces Need an AED?
A: It depends on regulations and risk levels. Airports, subways, stadiums, and nursing homes—high-traffic or high-risk areas—are strongly recommended to have AEDs. Installing AEDs improves public safety and emergency preparedness.
Q: Can an AED Be Used in Wet Environments?
A: Use with caution. Always: (1) move the patient to a dry surface; (2) wipe the chest thoroughly dry; (3) ensure pads are firmly attached to dry skin. If moisture cannot be removed, do not use the AED—water may disperse current and reduce effectiveness.