Cardiac Arrest and CPR

When the heart stops, the blood supply to the brain also stops. The victim will collapse unconscious and will be unresponsive. Breathing also stops, although it may take a few minutes to stop completely. For the first few minutes the victim may take noisy, infrequent or gasping breaths. The key features of cardiac arrest are therefore someone who is unconscious, unresponsive and not breathing normally. Taking noisy, infrequent or gasping breaths is not normal breathing.

If you have any doubt whether someone is breathing normally or not, assume that it is not normal: call for help immediately and start CPR.

Getting Immediate Help and Giving CPR

A cardiac arrest is an emergency. If you witness a cardiac arrest, you can increase the person’s chances of survival by getting help immediately and giving CPR.

RCUK Guidelines 2025 continues to prioritise supporting members of our communities to have the confidence, knowledge and skills to act when someone sustains an out-of-hospital cardiac arrest. The principles of CPR remain the same, and there is an increased emphasis on the difficulty in recognising cardiac arrest and the role that the ambulance service call handlers can play in facilitating this.

One of the biggest changes in the 2025 Guidelines is the instruction to call 999 as soon as you find someone unresponsive, before assessing breathing. This removes hesitation and speeds up emergency response. While waiting for the call to be answered — with your phone on speaker — you can assess breathing, and the call handler will guide you from there. This simplified flow reduces uncertainty and helps ensure help is activated as quickly as possible.

Who Do I Call?

Find out your location's emergency telephone number if in a healthcare setting Or Call the emergency services on 999 or 111 for urgent enquiries.

You can summon help at the scene using a mobile phone (put it on speaker phone). If it is not possible to telephone for help at the scene, send a bystander to fetch help. If possible, the victim should not be left alone at any stage. Only leave them if there is no other way of obtaining help.

Giving Information

When summoning or calling for help you need to be able to give as much accurate information as possible. You will not be expected to make a full diagnosis. If you are unsure of the full details or what has happened, give as much detail as you can:

Be clear about the help required: Suspected cardiac arrest
State whom/what you want: Resuscitation team in a hospital, otherwise an ambulance
Be clear about the location: Where are you, for example, room, floor, building, etc
Ask for a defibrillator, otherwise known as an automated external defibrillator or AED

Stay calm and repeat if necessary.

If the person is not breathing or not breathing normally, you need to give CPR.

Chest compressions

Kneel next to the person
Place the heel of one hand in the centre of their chest. Place your other hand on top of the first. Interlock your fingers. You'll find it easier if you have the hand you write with on top
With straight arms, use the heel of your hand to push the breastbone down firmly and smoothly, so that the chest is pressed down 5–6 cm and release without removing hands from the chest
Do this at a rate of 100 to 120 chest compressions per minute – that’s almost two per second
Give 30 chest compressions. You may find it helpful to count out loud

Rescue breaths

If you’d rather not give rescue breaths, then deliver hands-only CPR.

Open the airway again by tilting the head back and lifting the chin. Pinch the soft part of the person’s nose closed
Take a normal breath, make a seal around their mouth and breathe out steadily
The person’s chest should rise. Keeping the person's head back and the chin lifted, take your mouth away and you should see the patient's chest fall. Then give a second rescue breath. The two breaths should take no longer than 5 seconds

Repeat 30 chest compressions and two rescue breaths.

Keep going until professional help arrives and takes over, or the person starts to show signs of regaining consciousness, such as coughing, opening their eyes, speaking, or breathing normally.

Hands-only CPR is better than doing nothing.

If you are exhausted, instruct someone to continue while you regain energy.

What to do When Someone is Unconscious

Updated to 2025 RCUK Guidelines for Adult Basic Life Support in the Community Setting

If you come across someone who is unresponsive, you must do the following:

Check for Safety & Shout/call for help

Approach them with care. Is it safe to approach? Look out for hazards such as fire, traffic and electricity and never put yourself at risk.

Call 999 and ask for Ambulance Service immediately if they are unresponsive

Gently shake the person’s shoulders and ask loudly ‘Are you alright?’

Absent/Abnormal breathing? (Open the airway)

Place one hand on the person’s forehead, gently tilt their head back, then lift their chin using two fingers of your other hand under their chin – when you do this you open their airway.

30 chest compressions followed by 2 rescue breaths

Chest Compressions:

Interlock your fingers.
Place your hands in the centre of the chest.
Push down hard and then release twice per second, and don’t stop.
This rate of compressions should be 100-120 chest compressions per minute.

Rescue Breaths:

If you have been trained to provide rescue breaths, alternate 30 chest compressions with 2 rescue breaths.
When providing rescue breaths, deliver just enough air to make the chest start to rise; avoid excessive ventilation.
If you are unable to ventilate the chest after 2 attempts, consider foreign body airway obstruction (refer to first aid).
If you are not trained to provide or are unwilling to deliver rescue breaths, perform continuous chest compressions without interruptions.

Ask someone to fetch an Automated External Defibrillator (AED) if one is available or if the ambulance dispatcher identifies a local AED send someone else to fetch it

Early defibrillation is crucial as it gives a jolt of energy to the heart, which can help restore the heart's rhythm, and get it beating normally again. It's an easy piece of equipment to use, even without training, and can make the difference between life and death - so its important to use a defibrillator in an emergency.

As soon and AED arrives switch it on and follow instructions

As soon as an AED is available, attach it and follow the AED instructions.
Ensure correct pad placement so that the electrical current passes direclty through the heart muscle from one side of the chest to the other
The RCUK 2025 Update confirms the antero-lateral pad placement remains preferred position for adults.

Continue CPR until the ambulance service arrives

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