Author:
Kai Knudsen
Updated:
26 August, 2025
Here, guidelines for cardiopulmonary resuscitation (CPR) for both adults and children are described in accordance with the Heart-Lung Council. The graphical posters from the Swedish CPR Council are also available here, including those for airway obstruction in children.
Cardiopulmonary Resuscitation Adults
Effective circulation is fundamental in the care of critically ill patients. Cardiac arrest or cardiovascular collapse with insufficient circulation is common in emergency medicine and intensive care. Having a pre-planned strategy and access to relevant emergency equipment is essential for quickly and effectively managing cardiac arrest.
When cardiac arrest is strongly suspected start CPR
- Start with chest compressions
- 30 compressions followed by 2 breaths
- Hand placement in the center of the chest
- CPR should continue without interruption
- Do not pause for breathing or pulse checks
- Change the person performing compressions every two minutes
- Stop CPR only if spontaneous and normal breathing returns
Circulation
- Focus on good compressions without interruptions.
- Compression depth should be at least 5 cm.
- The compression rate should be at least 100/minute but not more than 120/minute.
- If you are untrained or unsure about CPR, you can perform chest compressions only while waiting for the ambulance.
- If trained, perform CPR at a ratio of 30:2 for adults and 15:2 for children.
Breathing
Abnormal, so-called agonal breathing is often a sign of cardiac arrest. A breath should visibly raise the chest, with an unspecified volume.
Intubation
Intubation should only be performed by experienced staff if it can be done with minimal interruptions to CPR.
Defibrillation
One defibrillation followed by two minutes of CPR. Minimize pauses in compressions before and after defibrillation as much as possible.
Medication
Adrenaline should be given at a dose of 1 mg every 3-5 minutes as before. Atropine is no longer considered for PEA/Asystole.
CPR – Practical Implementation
- Confirm cardiac arrest, alert emergency services, and retrieve emergency equipment
- Emergency bag
- Breathing mask/balloon/Ruben bag
- Defibrillator/EKG machine
- Documentation/Medical record
- CPR board
- Oxygen/Suction
Start CPR
Start with chest compressions, 100 per minute. 30:2 ratio. If untreated cardiac arrest > 5 minutes or unwitnessed cardiac arrest, begin with CPR for 2 minutes before analyzing. Compression frequency: 100 compressions per minute. Switch the person performing compressions after each 2-minute CPR period.
Analyze EKG Rhythm
Check pulse only if there is an organized rhythm.
Defibrillate
- Biphasic with strength 150/200 J
- Monophasic 360 J or according to manufacturer recommendations
- Do not defibrillate very fine VF
Adrenaline
Administer 1 mg IV every 4 minutes until return of spontaneous circulation (ROSC). For asystole/PEA, give the first dose immediately; for VF/VT, give after the third defibrillation.
Amiodarone
Give a one-time dose of 300 mg IV if VF/VT persists after the third defibrillation. Administer an additional 150 mg IV if VF/VT persists after two more defibrillations.
Primary CPR
Advanced CPR
CPR in drowning
CPR for Trauma Cases
Click the image to view the PDF version of the image.
Airway obstruction
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