CPR Protocol 2026 – How to Perform Adult CPR

Cardiopulmonary resuscitation, usually shortened to CPR, is an emergency procedure used when somebody is in cardiac arrest. Cardiac arrest occurs when the heart stops pumping blood effectively around the body. The casualty will become unresponsive and will normally be not breathing normally.

Immediate CPR helps maintain a limited supply of oxygenated blood to the brain and other vital organs until a normal heart rhythm can be restored.

In the UK, CPR guidance is produced by Resuscitation Council UK. The current 2025 Resuscitation Guidelines came into use on training courses from January 2026. While the fundamentals of CPR remain familiar, there has been an important change to the order in which rescuers are advised to summon help and assess breathing.

The 2026 Adult CPR Sequence

The most important principle is simple: if someone is unresponsive and is not breathing normally, treat them as being in cardiac arrest and begin CPR. We will use the mnemonic DRs ABCD which is very similar to the primary survey mnemonic DRc ABCDE

1. Check for Danger

Before approaching the casualty, make sure it is safe to do so.

Consider hazards to:

• yourself;
• the casualty;
• other people at the scene.

This might include traffic, electricity, fire, machinery, water or moving engine parts. Do not create another casualty by entering an unsafe situation. Remove any dangers first

2. Check for a Response

Approach the casualty and check whether they respond.

1. Speak loudly to them, “Hello Annie, Can you hear me? Are you alright?”
2. Give them a command “Annie, Annie, open your eyes for me”
3. and then gently shake their shoulders.

If they respond, assess their condition and obtain appropriate help. If they do not respond, they should be treated as unresponsive.

3. Shout for help

This is one of the significant changes introduced by the latest Resuscitation Council UK guidance.

Under the 2026 protocol, shout/call for help as soon as you establish that the casualty is unresponsive.

You no longer need to establish that they are not breathing normally before starting the emergency call. If another person is present, ask them to call 999 or call a Mayday. If you are alone and have a mobile phone, call 999 yourself and put the phone on speaker so that you can continue assessing and treating the casualty. You can assess the casualty’s breathing while waiting for the call to be answered. The ambulance service call handler can help you determine whether the casualty is in cardiac arrest and can provide CPR instructions if required.

4. Open Airway

Head-Tilt/Chin-Lift Technique

5. Check Breathing

Assess whether the casualty is breathing normally. If this is not obvious, use the Look, Listen & Feel techniques for 10 seconds. Place you cheek/ear over their mouth/nose and look down their chest

Look

Look to see if the chest is rising

Listen

Listen for any breathing

Feel

Attempt to feel their breathing on your cheek.

If they are unresponsive and their breathing is abnormal, assume cardiac arrest. Abnormal breathing may include:

• no breathing;
• occasional gasps;
• slow, laboured breathing;
• irregular breathing;
• panting or gasping.

These abnormal gasps are sometimes known as agonal breathing. They must not be confused with normal breathing.

Resuscitation Council UK also highlights that immediately following cardiac arrest, particularly during exercise or sporting activity, a casualty can sometimes appear to have a near-normal or panting breathing pattern. If you are uncertain whether breathing is normal, assume cardiac arrest and begin CPR. The potential harm caused by performing CPR on someone who does not ultimately prove to be in cardiac arrest is small compared with the consequences of delaying CPR when it is genuinely required.

6a. Call for Help, Start Chest Compressions & CPR

Call for help or advise a helper to do so. They need to dial 999 or make a Mayday call, telling the call handler or Coastguard that you “have a casualty not breathing normally and you have started CPR”. Ask the same or another person to get an AED if there is one available nearby.

Place the casualty on their back where they are. Place the heel of one hand in the centre of the chest, on the lower half of the sternum.

Place your other hand on top.

Interlock your fingers and keep your arms straight.

Position your shoulders vertically above your hands.

Compress the chest:

30 times

to about one third the depth of the chest

100–120 times per minute

Allow the chest to return fully to its normal position after every compression. Avoid leaning on the chest between compressions. Interrupt chest compressions as little as possible.

After 30 compressions:

1. Open the airway.
2. Pinch the casualty’s nose.
3. Seal your mouth around theirs.
4. Give a breath sufficient to make the chest begin to rise.
5. Give a second breath.
6. Immediately restart chest compressions.

Avoid blowing excessive amounts of air into the casualty.

The two breaths should cause as little interruption to chest compressions as possible.

What if You Cannot or Do Not Want to Give Rescue Breaths?

If you have not been trained to provide rescue breaths, perform continuous chest compressions.

The ambulance call handler will normally guide an untrained caller through compression-only CPR.

If the caller confirms that they know how to provide rescue breaths, the call handler can support them in performing 30:2 CPR.

For trained first aiders, particularly those operating in environments where drowning is possible, rescue breaths remain an important skill.

7. Get a Defib (AED)

An Automated External Defibrillator, or AED, should be brought to the casualty as quickly as possible.

If several people are available:

• one person should perform CPR;
• another should call 999 if this has not already been done;
• another should retrieve the AED.

The ambulance service may be able to tell you the location of the nearest registered defibrillator. Anyone can use an AED. No specialist medical qualification is required. As soon as the AED arrives:

1. Switch it on
2. Follow the spoken or visual instructions.

If another rescuer is performing CPR, they should continue chest compressions while the pads are being attached where possible.

When the AED says it is analysing the rhythm:

do not touch the casualty.

If a shock is advised:

• make sure nobody is touching the casualty;
• deliver the shock if instructed to do so;
• immediately restart CPR.

If the AED says no shock advised, immediately restart CPR. Continue following the AED instructions.

CPR Does Not Stop When the AED Arrives

A defibrillator does not replace CPR. The AED will periodically analyse the casualty’s heart rhythm. Between analyses, the rescuer should continue CPR as instructed. nThe combination of:

early recognition + early 999 call + early CPR + early defibrillation

provides the casualty with the greatest opportunity for survival. Bystander CPR combined with early AED use can increase the chances of survival from out-of-hospital cardiac arrest by approximately two to four times.

When Should CPR Stop?

Continue CPR until one of the following occurs:

• the casualty shows clear signs of life and begins breathing normally;
• the ambulance service or another suitably trained professional takes over;
• you become physically unable to continue;
• continuing would place you in danger.
• you are ainsteide by a Doctor over radio medical advise to stop

If another trained rescuer is available, change the person performing compressions when necessary to prevent fatigue while keeping interruptions to an absolute minimum.

Why High-Quality CPR Matters

During cardiac arrest the heart is no longer maintaining adequate circulation.

Chest compressions temporarily perform part of the heart’s job by creating pressure within the chest and moving a small but critically important volume of blood around the body.

Good-quality compressions therefore need to be:

• fast enough;
• deep enough;
• allowedhbyfy to recoil fully;
• interrupted as little as possible.

CPR does not normally restart the heart by itself. Its purpose is largely to maintain circulation until the underlying problem can be treated and, where appropriate, an AED can deliver a defibrillation shock.

The most important message, however, remains very simple: If somebody is unresponsive and is not breathing normally, call 999, start CPR and use an AED as soon as possible.

CPR for Children

This articled does not cover CPR for infants (under 12 months). A child is defined as anyone between 12 months old and puberty. Cardiac arrest in children is less common than in adults and is more likely to result from a respiratory problem rather than a primary heart problem. For that reason, rescue breaths are particularly important in paediatric CPR.

Follow the same sequels as adult CPR (above) with 2 ammenmnets

Under the current Resuscitation Council UK guidance, if a child is unresponsive:

1/. Five Initial Rescue Breaths for a child

The most obvious difference between routine adult CPR and paediatric CPR is the use of: 5 initial rescue breaths before beginning chest compressions (ie after checking breathing).

Open the child’s airway using head tilt and chin lift and give each breath over approximately one second, using enough air to make the chest visibly rise.

If the first breath does not make the chest rise, reposition the airway and try again. After the five initial breaths, if the child shows no signs of life, immediately begin chest compressions ans continue the usual 30:2 ratio  of compression to breaths (unless specifically trained in 15:2)

2/. Chest Compressions on a Child

Place the heel of one hand in the centre of the chest, over the lower half of the sternum. For a larger child, two hands may be required. For a smaller child you can reduce the strength of compressions by placing your care hand on the floor. Compress the chest by approximately one third of its depth.

CPR Following Drowning

Drowning requires particular consideration because the initial problem is normally lack of oxygen. Unlike many sudden adult cardiac arrests, where the heart may stop because of an electrical disturbance, a drowning casualty will usually become progressively hypoxic — meaning that the oxygen level in the body falls. This makes ventilation and rescue breaths especially important.

Rescue the Casualty Safely

Your own safety comes first.

If you are not trained in water rescue, do not enter the water and put yourself at risk.

Where possible:

• reach the casualty from the shore;
• throw a lifebuoy or flotation device;
• use suitable rescue equipment;
• call 999.

Trained rescuers should use rescue techniques and equipment appropriate to their level of training.

Five Rescue Breaths Following Drowning

Once the casualty is in a safe position, ashore, on a pontoon, on a slipway or aboard a rescue boat, check responsiveness.There are two key differences in the suspected drowning protocol

1/. Ensure the mouth is empty of water before opening the airway.

2/. If the casualty is unresponsive and is not breathing normally Give 5 initial rescue breaths before CPR, (just like the child CPR protocol), Call for help and begin standard CPR.

Rescue Breaths in the Water

Specialist water-rescue guidance permits appropriately trained rescuers to provide rescue breaths while still in the waterin certain circumstances.

This should only be attempted where:

• the rescuer is trained to do so;
• an effective flotation device is available;
• the casualty is unconscious and not breathing;
• providing breaths does not place the rescuer at unacceptable risk.

Otherwise, remove the casualty from the water as quickly and safely as possible and begin resuscitation on a stable surface.

CPR After Drowning

Because drowning is fundamentally an oxygen-related emergency, compression-only CPR is less desirable than CPR including rescue breaths.

If rescue breaths genuinely cannot be provided, however, chest compressions should still be started rather than doing nothing.

Using an AED After Drowning

An AED can be safely used following drowning.

Before attaching the pads: quickly dry the casualty’s chest. There is no need to waste time trying to make the casualty completely dry. Attach the AED pads to the dry chest and follow the machine’s instructions.

For drowning casualties, Resuscitation Council UK stresses that effective CPR and oxygenation take priority over delaying treatment to obtain an AED.

Do You Need to Drain Water From the Lungs?

No. Do not waste time:

• holding the casualty upside down;
• attempting to “drain” water from the lungs;
• pressing on the abdomen to expel water.

The priority is:

Airway → Breathing → Rescue breaths → CPR

Any water or vomit that enters the mouth during resuscitation can be dealt with as necessary, but attempts to deliberately drain the casualty delay essential ventilation and chest compressions.

Drowning and Hypothermia

A drowning casualty may also be hypothermic, particularly following prolonged immersion.

Remove wet clothing when practical, protect the casualty from further heat loss and begin rewarming. However, management of hypothermia must not delay CPR when the casualty is in cardiac arrest.

Children are particularly vulnerable to cooling because of their relatively large surface area compared with their body mass. Resuscitation Council UK therefore advises simultaneous treatment of hypoxia and hypothermia following paediatric drowning.

Following drowning, do not default to compression-only CPR if you are trained and able to provide rescue breaths. Oxygenation is a fundamental part of the resuscitation.

CPR Training

Reading about CPR is useful, but it cannot replace practical training.

Effective CPR requires the rescuer to develop practical skills including:

• recognising cardiac arrest;
• performing effective chest compressions;
• opening and managing an airway;
• providing rescue breaths;
• using an AED;
• working effectively with other rescuers.

Practical first aid training allows these skills to be practised on resuscitation manikins before they are ever required in a genuine emergency.

CPR is taught on all of our First Aid and Medical courses

• RYA First Aid
• HSE Emergency First Aid at Work
• HSE First Aid at Work
• HSE First Aid at Work (Re-qualification)
• Outdoor First Aid
• STCW Elementary First Aid
• STCW Medical First Aid
• STCW Medical Care
• STCW Medical Care (Update)
• CT First Aid Instructor
• RYA First Aid Instructor

Doug Innes
RYA First Aid Instructor Trainer & STCW Medical Care Assessor