CPR Guidelines 2026: Adult, Child, Drowning & AED

Adult CPR – Step by Step Guide

The 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. Look for letters in ORANGE to follow DRs ABCD.

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. Where possible, remove or control hazards before approaching the casualty. Do not put yourself at risk.

2. Check for 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. 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 & Send for a Defib

This is one of the significant changes introduced by the latest Resuscitation Council UK guidelines. As soon as you establish that the casualty is unresponsive, shout for help and ensure that 999 is called immediately. Do not wait until you have completed the breathing assessment. If several people are available:

• one person should continue with checks and then perform CPR (see below).
• another should dial 999 (112 outside UK) or make a DSC Distress alert and voice Mayday call.
• another should retrieve the defib.

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.

If you are unsure where the nearest Defib is, the call handler will tell you where the nearest Public Access Defib can be located.

4. Open Airway

Open the airway promptly. If visible water, vomit or other material is obstructing the mouth, clear it as necessary to allow effective ventilation. Do not attempt to drain water from the lungs or delay rescue breaths or CPR.

Head Tilt-Chin Lift Technique

Use this method for unresponsive casualties when you do not suspect a head or neck injury.

Jaw Thrust Manoeuvre

Use this method if you suspect a spinal, head, or neck injury to avoid moving the neck.

• Position yourself at the top of the person’s head.

5. Check Breathing

Assess whether the casualty is breathing normally. If this is not obvious, use Look, Listen & Feel for no more than 10 seconds. Position your ear close to the casualty’s mouth and nose while looking along 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.

6. Start Chest Compressions & CPR

If practical, tell the emergency services: “The casualty is unresponsive, is not breathing normally, and I have started CPR.” If you are alone and not on speaker phone this will not be practical at this time.

• Place the casualty on their back and begin CPR 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
  • at least 5 cm, but not more than 6 cm (on an average adult this is 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. Defib (AED)

An Automated External Defibrillator, or AED, should be brought to the casualty as quickly as possible. 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 Defib 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. The 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 instructed to stop by a suitably qualified medical professional providing radio medical advice.

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;
• allowed 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 can often be improved by the use of a face shield, face mask or BVM (Bag-valve mask). 

CPR for Children

This section covers CPR for children aged one year and older but does not cover infants under 12 months. Rescuers should use the paediatric algorithm when the casualty is considered a child, rather than an adult. 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.

The following explains the main differences between adult and child CPR for first aiders. Rescuers specifically trained in paediatric basic life support should follow their paediatric training. 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: Five initial rescue breaths before beginning chest compressions (i.e. 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. Give five initial rescue breaths. If the child remains unresponsive without signs of life, begin chest compressions.

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. Use one or two hands as appropriate for the child’s size and the rescuer’s ability to achieve effective compressions. Compress the lower half of the sternum by at least one-third of the depth of the chest, allowing full recoil after each compression.

• 15:2 for first aiders specifically trained in paediatric basic life support.

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 and breathing as described above.

If a drowning casualty is unresponsive and not breathing normally, call for emergency assistance immediately, preferably using another rescuer. Open the airway and give five initial rescue breaths before starting chest compressions.  For adults, continue with 30 chest compressions followed by two rescue breaths (30:2). For children, use 15:2 if specifically trained in paediatric basic life support, or 30:2 otherwise. If alone, call 999 using a phone on speaker where possible.

Rescue Breaths in the Water

Specialist water-rescue guidance permits appropriately trained rescuers to provide rescue breaths while still in the water in 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. Profound hypothermic cardiac arrest may require a modified resuscitation approach under specialist guidance.

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 Comparison

	Adult CPR	Child CPR	Drowning
5 Initial Rescue Breaths	No	✅	✅
CPR Ratio	30:2	15:2 or 30:2*	30:2 (for adults)
Depth of Compressions	5-6cm	1/3 of the chest	By age
AED	✅	✅	✅

*15:2 for rescuers trained in paediatric basic life support; otherwise 30:2.

CPR – Frequently Asked Questions (FAQs)

What are the latest UK CPR guidelines for 2026?

One of the main changes introduced by Resuscitation Council UK is that rescuers should call 999 as soon as they establish that a casualty is unresponsive, rather than waiting until they have assessed breathing. Other important principles remain unchanged, including high-quality chest compressions, rescue breaths for trained first aiders and early use of an AED.

What is the correct CPR ratio for an adult?

The adult CPR ratio is 30 chest compressions followed by two rescue breaths (30:2) for rescuers trained to provide rescue breaths. Compressions should be delivered at 100–120 per minute, to a depth of at least 5 cm but not more than 6 cm, allowing the chest to recoil fully between compressions.

What is the difference between adult and child CPR?

Children should receive five initial rescue breaths before chest compressions begin. Rescuers specifically trained in paediatric basic life support use a ratio of 15 compressions to two breaths (15:2). Other first aiders use 30:2. Chest compressions should be at least one-third of the depth of the child’s chest.

Is CPR different following drowning?

Yes. Drowning normally causes cardiac arrest through a lack of oxygen. Consequently, rescue breaths are particularly important. If a drowning casualty is unresponsive and not breathing normally, give five initial rescue breaths before starting chest compressions. Continue at 30:2 for adults, or 15:2 for children if specifically trained in paediatric basic life support (30:2 otherwise). Do not attempt to drain water from the lungs.

Should I give compression-only CPR?

Rescuers trained and able to provide breaths should use 30 chest compressions followed by two breaths for adult CPR. If you are untrained or unable to give breaths, continuous chest compressions are recommended rather than doing nothing. Rescue breaths are particularly important for children and drowning casualties because lack of oxygen is often the cause of cardiac arrest.

Can you use an AED on a wet casualty or after drowning?

Yes. An automated external defibrillator (AED) can be used following drowning. Quickly dry the casualty’s chest before attaching the pads and follow the AED’s spoken instructions. Do not waste time drying the entire casualty. Following drowning, effective rescue breaths and CPR remain priorities while the AED is obtained and prepared.

Can you use an AED on a child?

Yes. AEDs can be used on children of all ages, including infants. For children under approximately eight years old or weighing less than 25 kg, use a paediatric setting where available. If it is unavailable, use the AED in adult mode. Ensure the electrode pads are positioned correctly and do not touch each other.

Should I start CPR if I am unsure whether somebody is breathing normally?

Yes. If someone is unresponsive, call 999 immediately and assess their breathing while waiting for the call to be answered. If they are not breathing normally, or you are unsure, assume cardiac arrest and begin CPR. Occasional gasps, irregular breathing or panting may be agonal breathing, which is not normal breathing. The risk of harm from performing CPR unnecessarily is much smaller than the risk of delaying CPR during a genuine cardiac arrest.

CPR Training

This article is based on the Resuscitation Council UK 2025 Guidelines, applied in training from 2026. It is intended as an educational reference and does not replace practical first aid training or emergency medical advice.

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.

At Chieftain Training, our first aid courses place particular emphasis on emergencies afloat and in watersports environments, including drowning, hypothermia, confined working spaces and situations where emergency assistance may be delayed. CPR is taught on all 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