Cardiopulmonary resuscitation (CPR) is one of the most critical life-saving interventions in healthcare. It is a skill that bridges the gap between life and death when a patient experiences cardiac arrest.
For respiratory therapists and other healthcare professionals, CPR is more than just a certification requirement. It is a core competency that directly impacts patient survival, neurological outcomes, and overall quality of care.
Understanding what CPR is, how it works, and why it is especially relevant to respiratory care is essential for anyone involved in cardiopulmonary medicine.
What Is Cardiopulmonary Resuscitation?
Cardiopulmonary resuscitation (CPR) is an emergency life-saving procedure used when a person’s heart stops beating or they stop breathing. It combines chest compressions and artificial ventilation to help maintain blood circulation and oxygen delivery to vital organs, especially the brain and heart.
When cardiac arrest occurs, the body quickly loses its ability to circulate oxygen-rich blood, which can lead to brain damage or death within minutes. CPR helps temporarily restore blood flow and oxygenation until advanced medical care, such as defibrillation or medication administration, can be provided.
CPR can be performed by trained healthcare professionals or bystanders in emergency situations. High-quality CPR involves performing chest compressions at the correct depth and rate while minimizing interruptions and providing effective ventilations when appropriate. It is a critical component of the chain of survival and significantly increases the chances of survival and positive neurological outcomes in patients experiencing cardiac or respiratory arrest.
Physiology of Circulation and Oxygenation
To understand CPR’s importance, it helps to briefly review the physiology of circulation and oxygenation.
Under normal conditions:
- The heart pumps oxygenated blood from the lungs to the body.
- Oxygen is delivered to tissues.
- Carbon dioxide is removed and transported back to the lungs for elimination.
In cardiac arrest, this entire system collapses. Blood flow stops, oxygen delivery ceases, and carbon dioxide accumulates. Without intervention, cellular death begins rapidly.
Chest compressions during CPR create artificial circulation by manually compressing the heart between the sternum and the spine. This generates forward blood flow, albeit at a reduced efficiency compared to normal cardiac output. Assisted ventilations help deliver oxygen to the alveoli, where it can diffuse into the bloodstream and be transported to vital organs.
Note: The goal is not to fully restore normal physiology but to provide enough perfusion and oxygenation to prevent irreversible damage.
Types of CPR
There are two primary forms of CPR commonly discussed in healthcare settings:
- Hands-Only CPR: This involves continuous chest compressions without rescue breaths. It is recommended for untrained bystanders in out-of-hospital cardiac arrest situations. The emphasis is on maintaining uninterrupted compressions to sustain blood flow.
- Conventional CPR: This includes both chest compressions and rescue breaths. In healthcare settings, especially in hospitals, this is the standard approach. It is particularly important in cases of respiratory arrest, drowning, drug overdose, or pediatric emergencies, where oxygenation is a major contributing factor.
Note: Respiratory therapists are almost always involved in conventional CPR, as airway management and ventilation are central components of their role.
CPR in the Hospital Setting
In hospitals, CPR is part of a coordinated response known as a “code blue.” A multidisciplinary team responds, including physicians, nurses, respiratory therapists, and other support staff.
Key components of in-hospital CPR include:
- Immediate high-quality chest compressions
- Advanced airway placement (such as endotracheal intubation)
- Bag-valve-mask ventilation
- Mechanical ventilation setup
- Defibrillation for shockable rhythms
- Administration of medications like epinephrine
Note: Respiratory therapists play a pivotal role in this process, especially in managing the airway and ensuring effective ventilation.
Why CPR Is Relevant to Respiratory Therapists
CPR is deeply intertwined with the profession of respiratory care. While cardiac arrest is often perceived as a “heart problem,” it is also fundamentally a problem of oxygen delivery and ventilation.
1. Airway Management
One of the most critical aspects of CPR is securing and maintaining a patent airway. Respiratory therapists are experts in airway management, including:
- Bag-valve-mask ventilation
- Endotracheal intubation (in some settings)
- Supraglottic airway placement
- Ventilator setup and management
Note: Improper ventilation during CPR can lead to inadequate oxygenation, gastric insufflation, or increased intrathoracic pressure, which may decrease venous return and cardiac output. Respiratory therapists ensure that ventilation is delivered effectively and safely.
2. Ventilation and Oxygenation
High-quality chest compressions are essential, but without adequate oxygenation, perfusion alone is insufficient. Respiratory therapists are responsible for:
- Delivering appropriate tidal volumes
- Avoiding hyperventilation
- Monitoring oxygen saturation and end-tidal CO₂
- Adjusting oxygen concentrations
Note: Hyperventilation during CPR is a common mistake and can be detrimental. Excessive ventilation increases intrathoracic pressure, which reduces cardiac output during compressions. Respiratory therapists help prevent this by controlling rate and volume.
3. Monitoring End-Tidal CO₂
Capnography plays an important role during resuscitation. End-tidal CO₂ (EtCO₂) monitoring provides real-time feedback on:
- Quality of chest compressions
- Adequacy of ventilation
- Return of spontaneous circulation (ROSC)
Note: A sudden increase in EtCO₂ may indicate that the heart has resumed effective pumping. Respiratory therapists are often responsible for setting up and interpreting capnography during a code.
4. Post-Resuscitation Care
Once return of spontaneous circulation (ROSC) occurs, the patient often requires advanced ventilatory support. Respiratory therapists manage:
- Mechanical ventilation settings
- Oxygen titration
- Lung-protective strategies
- Arterial blood gas analysis
Note: Post-cardiac arrest care is critical for improving neurological outcomes. Proper oxygenation and ventilation are essential during this phase.
CPR and Respiratory Arrest
Not all arrests begin with a primary cardiac cause. In many cases, especially in respiratory care settings, respiratory failure precedes cardiac arrest.
Common causes include:
- Severe hypoxemia
- Airway obstruction
- Drug overdose
- Neuromuscular failure
- Advanced COPD exacerbations
Note: In these cases, early recognition and intervention by respiratory therapists can prevent progression to full cardiac arrest. Effective airway management and ventilation can often reverse respiratory arrest before the heart stops. This highlights why CPR training and rapid response skills are so essential in respiratory care.
The Importance of High-Quality CPR
High-quality CPR significantly improves survival rates. Key elements include:
- Adequate compression depth and rate
- Full chest recoil
- Minimal interruptions
- Avoiding excessive ventilation
Note: For respiratory therapists, coordination with the compression provider is vital. Ventilations must be synchronized appropriately, especially once an advanced airway is in place. Team communication, role clarity, and adherence to established guidelines are critical for optimal outcomes.
CPR Certification and Ongoing Competency
Respiratory therapists are typically required to maintain certifications such as Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS). These programs provide standardized training in:
- Recognition of cardiac rhythms
- Defibrillation
- Medication administration
- Airway management algorithms
- Team dynamics during resuscitation
Note: Ongoing practice is essential. CPR skills can deteriorate without regular training. Simulation-based education and mock codes help respiratory therapists maintain readiness and confidence.
Ethical and Emotional Considerations
Participating in resuscitation efforts can be emotionally challenging. Not all patients survive, even with optimal care. Respiratory therapists must balance clinical objectivity with compassion.
Ethical considerations may include:
- Do-not-resuscitate (DNR) orders
- End-of-life care discussions
- Futility of resuscitation efforts
Note: Understanding when CPR is appropriate and when it aligns with patient wishes is an important part of professional practice.
CPR in the Community and Public Health
Beyond the hospital, CPR training has a profound impact on community health. Bystander CPR significantly increases survival in out-of-hospital cardiac arrest.
Respiratory therapists often serve as educators in their communities, teaching CPR skills and promoting awareness. Expanding CPR knowledge among the general public helps strengthen the chain of survival.
Cardiopulmonary Resuscitation (CPR) Practice Questions
1. What is cardiopulmonary resuscitation (CPR)?
Cardiopulmonary resuscitation (CPR) is an emergency lifesaving procedure that uses chest compressions and ventilations to maintain circulation and oxygenation when a patient experiences cardiac arrest.
2. Why is CPR critical during cardiac arrest?
CPR helps maintain blood flow to vital organs, especially the brain and heart, delaying tissue damage until advanced medical care can be provided.
3. How quickly can brain injury begin after cardiac arrest without oxygen?
Irreversible brain injury can begin within approximately 4 to 6 minutes without adequate oxygen delivery.
4. What are the primary components of CPR?
The primary components of CPR include high-quality chest compressions, assisted ventilations, and early use of an automated external defibrillator (AED).
5. What are the key signs indicating that CPR is needed?
CPR is indicated when a person is unresponsive, not breathing normally, and has no detectable pulse.
6. What should a rescuer do first upon arriving at an emergency scene?
The rescuer should ensure that the scene is safe before approaching the victim.
7. What should a rescuer do if the emergency scene is unsafe?
The rescuer should move the victim to a safe location if it can be done without causing further harm.
8. How soon should CPR be initiated after recognizing cardiac arrest?
CPR should be started within 10 seconds after confirming cardiac arrest.
9. How long should interruptions in chest compressions be limited to?
Interruptions in chest compressions should be limited to no more than 10 seconds.
10. How can a rescuer determine that rescue breaths are effective?
Rescue breaths are effective when visible chest rise is observed.
11. What is the preferred method to open the airway when no spinal injury is suspected?
The head tilt–chin lift maneuver is the preferred method for opening the airway.
12. Why is the head tilt–chin lift maneuver avoided when spinal injury is suspected?
It may worsen spinal cord injury; instead, a jaw-thrust maneuver should be used.
13. Why is excessive ventilation during CPR harmful?
Excessive ventilation can cause gastric inflation, vomiting, aspiration, and reduced venous return to the heart.
14. What is the recommended compression-to-ventilation ratio for adult CPR without an advanced airway?
The recommended ratio is 30 compressions to 2 breaths.
15. How can rescuers ensure proper cardiac refill during compressions?
Rescuers must allow complete chest recoil between compressions.
16. Why should rescuers switch roles during CPR?
Switching roles approximately every 5 cycles helps prevent fatigue and maintains compression quality.
17. What is the recommended compression rate for CPR in adults?
Chest compressions should be delivered at a rate of 100 to 120 compressions per minute.
18. What is the first step when using an automated external defibrillator (AED)?
The first step is to turn on the AED and follow the voice prompts.
19. What is the recommended chest compression depth for children?
The recommended compression depth for children is approximately 2 inches (5 cm).
20. What should a rescuer do if a choking adult becomes unresponsive?
The rescuer should carefully lower the victim to the floor and begin CPR.
21. What is the recommended compression-to-ventilation ratio for one-rescuer infant CPR?
The recommended ratio is 30 compressions to 2 breaths.
22. What is the preferred compression technique for two-rescuer infant CPR?
The preferred technique is the two-thumb encircling hands method.
23. Which pulse should be checked in infants during CPR?
The brachial pulse should be assessed in infants.
24. What is the recommended compression-to-ventilation ratio for two-rescuer infant CPR?
The recommended ratio is 15 compressions to 2 breaths.
25. What is the recommended chest compression depth for infants?
The recommended depth is approximately 1.5 inches (4 cm), or about one-third the depth of the chest.
26. What is the recommended compression technique for single-rescuer infant CPR?
The two-finger compression technique is recommended.
27. After how many cycles should rescuers switch roles during CPR?
Rescuers should switch roles after approximately 5 cycles of compressions and ventilations.
28. When performing two-rescuer CPR with an AED, when should rescuers switch roles?
Rescuers should switch roles while the AED is analyzing the rhythm.
29. What safety command should be given before delivering a shock with an AED?
The rescuer should loudly state, “Clear,” ensuring no one is touching the patient.
30. What steps should be taken if a collapse is witnessed?
Activate emergency medical services, obtain an AED, begin CPR with 30 compressions and 2 breaths, and continue until help arrives.
31. What steps should be taken if an unconscious person is found and the collapse was not witnessed?
Check responsiveness, call for help, activate the AED, assess breathing and pulse, and begin CPR if needed.
32. Why are high-quality chest compressions emphasized during CPR?
High-quality compressions maintain adequate blood flow and improve survival outcomes.
33. Why is early defibrillation important during cardiac arrest?
Early defibrillation increases the likelihood of restoring a normal heart rhythm and improves survival rates.
34. What is the primary physiological purpose of CPR?
The primary physiological purpose of CPR is to maintain artificial circulation and oxygenation when the heart and lungs are unable to function effectively.
35. What normally happens to oxygen and carbon dioxide during healthy circulation?
Under normal conditions, oxygenated blood is delivered to body tissues while carbon dioxide is transported back to the lungs for elimination.
36. What physiological changes occur during cardiac arrest?
During cardiac arrest, blood circulation stops, oxygen delivery ceases, and carbon dioxide accumulates, leading to rapid cellular injury and death.
37. How do chest compressions create artificial circulation?
Chest compressions compress the heart between the sternum and spine, generating forward blood flow to vital organs.
38. Why are rescue breaths important during CPR?
Rescue breaths deliver oxygen to the lungs, allowing gas exchange to occur and supporting oxygen transport to tissues.
39. What is the main goal of CPR?
The goal of CPR is to maintain enough perfusion and oxygenation to prevent irreversible organ damage until normal circulation is restored.
40. What is hands-only CPR?
Hands-only CPR is a technique that involves continuous chest compressions without rescue breaths and is recommended for untrained bystanders.
41. In which situations is conventional CPR preferred over hands-only CPR?
Conventional CPR is preferred in cases involving respiratory arrest, drowning, drug overdose, or pediatric emergencies where oxygenation is critical.
42. What is a code blue in the hospital setting?
A code blue is an emergency response activated for patients experiencing cardiac or respiratory arrest requiring immediate resuscitation.
43. What is the role of respiratory therapists during in-hospital CPR?
Respiratory therapists assist with airway management, ventilation, oxygen delivery, and ventilator setup during resuscitation efforts.
44. Why is airway management important during CPR?
Proper airway management ensures that oxygen can be delivered effectively to the lungs and prevents airway obstruction.
45. What airway devices may be used during CPR?
Airway devices used during CPR include bag-valve masks, endotracheal tubes, and supraglottic airway devices.
46. Why is avoiding hyperventilation important during CPR?
Hyperventilation increases intrathoracic pressure, which reduces venous return to the heart and decreases cardiac output during compressions.
47. What role does tidal volume play during CPR ventilation?
Appropriate tidal volume ensures effective oxygen delivery while minimizing the risk of lung injury and gastric inflation.
48. Why is monitoring oxygen saturation important during CPR?
Monitoring oxygen saturation helps ensure adequate oxygen delivery and guides adjustments in oxygen therapy.
49. What is end-tidal carbon dioxide (EtCO₂) monitoring used for during CPR?
EtCO₂ monitoring provides feedback on the quality of chest compressions, adequacy of ventilation, and detection of return of spontaneous circulation.
50. What does a sudden rise in EtCO₂ often indicate during CPR?
A sudden increase in EtCO₂ may indicate return of spontaneous circulation (ROSC).
51. What is return of spontaneous circulation (ROSC)?
ROSC refers to the restoration of a sustained and effective heartbeat following cardiac arrest.
52. Why is post-resuscitation ventilatory support often necessary after ROSC?
Patients frequently require ventilatory support to maintain oxygenation, stabilize gas exchange, and prevent secondary injury.
53. What ventilator strategies are commonly used after ROSC?
Lung-protective ventilation strategies are used to prevent ventilator-induced lung injury and optimize oxygenation.
54. Why are arterial blood gases important after resuscitation?
Arterial blood gases help evaluate oxygenation, ventilation, and acid-base status to guide treatment decisions.
55. What is respiratory arrest?
Respiratory arrest occurs when breathing stops or becomes ineffective while the heart may still be beating.
56. How can respiratory arrest lead to cardiac arrest?
Respiratory arrest leads to severe hypoxemia, which can eventually cause the heart to stop beating.
57. What are common causes of respiratory arrest?
Common causes include airway obstruction, severe hypoxemia, drug overdose, neuromuscular disorders, and advanced COPD exacerbations.
58. How can early intervention prevent cardiac arrest in respiratory failure?
Early airway management and ventilation support can restore oxygenation and prevent progression to cardiac arrest.
59. Why are respiratory therapists essential in managing respiratory arrest?
Respiratory therapists specialize in airway management, ventilation, and oxygen delivery, making them critical in preventing and treating respiratory failure.
60. What is the relationship between ventilation and perfusion during CPR?
Effective ventilation provides oxygen, while chest compressions maintain perfusion, both of which are necessary to sustain organ function.
61. Why is continuous chest compression emphasized during CPR?
Continuous compressions maximize blood flow and improve the likelihood of survival.
62. How does intrathoracic pressure affect CPR effectiveness?
Excessive intrathoracic pressure can reduce venous return, lowering cardiac output during resuscitation.
63. What is the importance of coordinated team effort during in-hospital CPR?
A coordinated team ensures efficient performance of compressions, airway management, medication delivery, and monitoring, improving patient outcomes.
64. Why is rapid recognition of cardiac arrest critical?
Rapid recognition allows immediate initiation of CPR, which significantly improves survival and neurological outcomes.
65. How does CPR support brain survival during cardiac arrest?
CPR maintains partial blood flow and oxygen delivery to the brain, delaying irreversible neurological damage.
66. Why is high-quality CPR important during cardiac arrest?
High-quality CPR improves survival rates by maintaining adequate circulation and oxygen delivery to vital organs until advanced care can be provided.
67. What are the key components of high-quality CPR?
Key components include appropriate compression depth and rate, complete chest recoil, minimal interruptions, and avoidance of excessive ventilation.
68. Why is full chest recoil important during CPR?
Full chest recoil allows the heart to refill with blood between compressions, improving cardiac output during resuscitation.
69. Why should interruptions during chest compressions be minimized?
Interruptions reduce blood flow to vital organs and decrease the effectiveness of CPR.
70. How should ventilation be coordinated once an advanced airway is placed?
Ventilations should be delivered asynchronously with continuous compressions, typically at a rate of one breath every 6 seconds.
71. Why is teamwork important during CPR?
Effective teamwork improves efficiency, reduces delays in treatment, and ensures coordinated delivery of life-saving interventions.
72. What certifications are commonly required for respiratory therapists involved in resuscitation?
Respiratory therapists typically maintain Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS) certifications.
73. What skills are taught in ACLS training?
ACLS training includes cardiac rhythm recognition, defibrillation, medication administration, airway management, and team-based resuscitation.
74. Why is ongoing CPR training necessary?
CPR skills can deteriorate over time, making regular practice and simulation training essential for maintaining competency.
75. What is clinical death?
Clinical death occurs when the heart stops beating and breathing ceases.
76. What is biological death?
Biological death occurs when irreversible cellular damage and tissue breakdown begin, typically 4 to 6 minutes after oxygen deprivation.
77. What does the acronym CABD represent in CPR?
CABD stands for Circulation, Airway, Breathing, and Defibrillation.
78. What is the function of an automated external defibrillator (AED)?
An AED delivers an electrical shock to restore a normal heart rhythm during certain types of cardiac arrest.
79. What airway maneuver is commonly used to open the airway when spinal injury is not suspected?
The head tilt–chin lift maneuver is used to open the airway when spinal injury is not suspected.
80. When should the jaw-thrust maneuver be used?
The jaw-thrust maneuver is used to open the airway when cervical spine injury is suspected.
81. What is the recommended compression-to-ventilation ratio for adult CPR?
The recommended ratio is 30 compressions to 2 breaths.
82. Where should rescuers check for a pulse in an adult patient?
Rescuers should check the carotid artery for a pulse in adult patients.
83. Where should chest compressions be performed on an adult?
Chest compressions should be performed on the lower half of the sternum while avoiding the xiphoid process.
84. What is the recommended compression depth for adults during CPR?
The recommended compression depth for adults is at least 2 inches (5 cm).
85. What is the recommended compression rate for CPR in all age groups?
The recommended compression rate is 100 to 120 compressions per minute.
86. What is the recommended compression depth for children during CPR?
The recommended compression depth for children is approximately one-third the depth of the chest, or about 2 inches (5 cm).
87. What is the recommended compression depth for infants during CPR?
The recommended compression depth for infants is approximately one-third the depth of the chest, or about 1.5 inches (4 cm).
88. Where is the pulse checked in infants during CPR?
The brachial artery is used to assess pulse in infants.
89. What is the preferred compression technique for two-rescuer infant CPR?
The preferred technique is the two-thumb encircling hands technique.
90. What is the compression-to-ventilation ratio for two-rescuer CPR in children and infants?
The recommended ratio is 15 compressions to 2 breaths.
91. What is the first step when a rescuer arrives at a cardiac arrest scene with an AED?
The rescuer should immediately turn on the AED and follow its prompts.
92. When should rescuers switch roles during two-rescuer CPR?
Rescuers should switch roles approximately every 2 minutes or every 5 cycles of CPR.
93. What is the proper response for an adult who becomes unconscious during choking?
The rescuer should lower the victim to the floor and begin CPR.
94. What defines an incomplete airway obstruction in a choking victim?
Incomplete obstruction occurs when the victim can cough, speak, or make sounds and should be encouraged to continue coughing.
95. What defines a complete airway obstruction in a choking victim?
Complete obstruction occurs when the victim cannot breathe, speak, cough, or make sounds and requires immediate intervention.
96. What should be done if an unconscious choking victim has a visible object in the airway?
The rescuer should remove the object using a finger sweep only if it is clearly visible.
97. What is the recommended treatment for choking in an infant?
Treatment involves alternating five back blows with five chest thrusts.
98. When is a bag-valve mask device commonly used during CPR?
A bag-valve mask is typically used during two-rescuer CPR to provide assisted ventilation.
99. What is the adult chain of survival for out-of-hospital cardiac arrest?
It includes early recognition, early CPR, rapid defibrillation, advanced life support, and post-cardiac arrest care.
100. What is the difference between a heart attack and sudden cardiac arrest?
A heart attack results from blocked blood flow to the heart muscle, whereas sudden cardiac arrest occurs when the heart abruptly stops beating due to electrical malfunction.
Final Thoughts
Cardiopulmonary resuscitation (CPR) is more than a life-saving technique. It is a foundational skill that integrates circulation, ventilation, teamwork, and rapid clinical decision-making. For respiratory therapists, CPR represents the intersection of airway expertise and emergency response.
From managing ventilation during active resuscitation to optimizing post-arrest care, respiratory therapists play a vital role in improving patient outcomes.
Mastery of CPR principles, ongoing training, and a commitment to high-quality care ensure that respiratory professionals remain essential members of the resuscitation team in every clinical setting.
Written by:
John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.
References
- Goyal A, Singh B, Patel PH. Cardiopulmonary Resuscitation. [Updated 2025 Jun 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.