Every victim in cardiac arrest requires high-quality CPR, regardless of age. Adults, children, and infants all need immediate chest compressions and rescue breaths when they are unresponsive, not breathing normally, and have no signs of life. There is no category of cardiac arrest victim that requires a lesser standard of CPR. The techniques differ slightly by age group, but the quality standard applies equally to all.
How to Recognize a Victim Who Needs CPR
The trigger for starting CPR is the same across all age groups: the person is unresponsive and has abnormal breathing, which includes gasping or no breathing at all. You do not need to detect a pulse before starting. The American Heart Association notes that both laypeople and healthcare professionals have high error rates when checking for a pulse, and delays caused by pulse checks can be harmful. If someone has no signs of life, start CPR immediately.
If you are a trained healthcare provider, you can attempt a pulse check, but it should take no longer than 10 seconds. If you don’t feel a definite pulse within that window, begin compressions.
What Makes CPR “High Quality”
High-quality CPR is defined by a specific set of performance metrics. These are the numbers that matter:
- Compression rate: 100 to 120 compressions per minute
- Compression depth: At least 2 inches (5 cm) in adults, at least one-third the depth of the chest in children and infants
- Full chest recoil: Let the chest come all the way back up between each compression
- Chest compression fraction: Spend at least 80% of the total resuscitation time actively compressing the chest
- No excessive ventilation: Deliver breaths without over-inflating the lungs
That 80% compression fraction is a key detail many people miss. It means minimizing all pauses, whether for breaths, rhythm checks, or switching rescuers. Every second without compressions reduces the victim’s chance of survival.
How Technique Differs by Age
While the quality standards are universal, the physical technique changes depending on the victim’s size.
For adults, compress the chest at least 2 inches deep using two hands placed on the center of the chest. The compression-to-breath ratio is 30:2, and this stays the same whether one or two rescuers are present.
For children (roughly age 1 through puberty), the target depth is at least one-third the front-to-back diameter of the chest, which works out to about 2 inches for most children. You may use one or two hands depending on the child’s size. A single rescuer uses the 30:2 ratio, but when two rescuers are available, the ratio shifts to 15:2. This gives the child more breaths per minute, which matters because pediatric cardiac arrests are more often caused by breathing problems than by heart rhythm issues.
For infants (under age 1), compress at least one-third the chest depth using two fingers or the two-thumb encircling technique. The same ratio rules apply: 30:2 for a lone rescuer, 15:2 with two rescuers.
Drowning Victims: A Key Exception
The general rule in modern CPR is to start with chest compressions before giving breaths (the C-A-B sequence). Drowning is the major exception. Because drowning causes cardiac arrest through oxygen deprivation rather than a heart rhythm problem, restoring airflow to the lungs is the priority.
For a drowning victim, start with 5 initial rescue breaths rather than the usual 2. This higher number accounts for water in the airways making the first breaths harder to deliver effectively. After those 5 breaths, continue with cycles of 30 compressions and 2 breaths. Compression-only CPR, which can be effective for witnessed adult cardiac arrests from heart-related causes, is specifically not recommended for drowning.
Why Compressions Matter More Than You Think
When the heart stops, blood pressure drops to zero within seconds. Chest compressions act as a manual pump, generating enough blood flow to keep the brain and heart alive until normal rhythm can be restored. But this artificial circulation is fragile. Each time you pause compressions, the pressure you’ve built up drops rapidly, and the first several compressions after a pause are less effective as pressure rebuilds.
This is why the guidelines emphasize minimizing interruptions so strongly. Switching rescuers every 2 minutes helps maintain compression quality, since fatigue causes depth to decrease even when the rescuer doesn’t notice. When you do switch, aim to make the transition in under 5 seconds.
When CPR Should Not Be Started or Can Be Stopped
There are limited situations where CPR should not begin. If there are obvious signs of irreversible death, such as rigor mortis or dependent lividity (pooling of blood creating discoloration in the lowest parts of the body), resuscitation is not appropriate. The same applies when a valid do-not-resuscitate order is present, or when performing CPR would put the rescuer in serious danger.
Once CPR has started, you should continue until one of the following happens: the person shows signs of life and starts breathing on their own, emergency medical personnel arrive and take over, an AED is ready to analyze the heart rhythm, or you are physically too exhausted to keep going. For trained EMS providers, additional protocols guide when to stop resuscitation in the field, but for bystanders the message is simpler: keep going until help arrives.
Putting It All Together
The answer to “which victim requires high-quality CPR” is straightforward: all of them. An adult who collapses from a heart attack, a child who stops breathing from an allergic reaction, an infant found unresponsive, a teenager pulled from a pool. The compression rates, depths, and ratios may vary with the victim’s age and the cause of the arrest, but the standard of quality never drops. Fast compressions, adequate depth, full recoil, minimal interruptions, and appropriate ventilation give every victim the best chance of survival.