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It's distressing to imagine, but what would you do if someone in your home suddenly collapsed and stopped breathing? After calling 911, many people feel helpless during such an event, which is usually due to a cardiac arrest (see "What is cardiac arrest?").

But if you immediately begin cardiopulmonary resuscitation (CPR), the chest compressions can keep blood flowing to the person's brain and other vital organs. Each year, more than 350,000 people in the United States experience an out-of-hospital cardiac arrest. Nearly three of every four of these happen at home, which means the life you potentially save with CPR is likely a loved one or friend.

"The two interventions that unequivocally save lives are high-quality chest compressions and early use of an automated external defibrillator, or AED," says Dr. Scott Goldberg, assistant professor of emergency medicine at Harvard Medical School. Emergency personnel will bring and use an AED, which shocks the heart back into a normal rhythm. Nationwide, the average response time for emergency medical services is seven minutes. A person experiencing a cardiac arrest is almost twice as likely to survive if someone administers high-quality chest compressions during that time, says Dr. Goldberg.

CPR training options

In the United States, bystander CPR training rates remain low; fewer than one in five adults are currently certified, according to the American Heart Association (AHA), which publishes the official guidelines for CPR. But the AHA and other organizations have begun moving away from advocating formal, in-person classes. "While there's a benefit to practicing your skills with an instructor who can give you real-time feedback, there's a trade-off," says Dr. Goldberg, noting that in-person classes are time-consuming and can be expensive.

One reason is that most classes include instruction beyond just learning CPR. Most also teach how to use an AED, since these devices are now widely available in airports, malls, casinos, sports arenas, and many office buildings. If you witness a cardiac arrest in a public place, ask a bystander to find one while you do chest compressions. AEDs use voice prompts, lights, and text messages to guide users through the needed steps.

Many classes teach CPR with rescue breathing (also called mouth-to-mouth breathing) done with face shields or special plastic masks. Some also feature basic first aid training. Although some of the training can be done online, the in-person training portion typically takes two hours. However, the AHA also offers a course called Heartsaver Virtual. It includes a training kit featuring a mannequin torso that's sent to your home plus a smartphone app that enables an instructor to watch and evaluate your chest compression technique.

Learning chest compressions

But even if you don't have the opportunity to take a class, you can still learn how to do chest compressions. A demonstrates the basic steps and also shows the location of more than 30 kiosks (including six at major airports) throughout the United States where you can practice chest compressions on a mannequin.

Also worth noting: about half of the 911 operators in the United States are trained to provide verbal cues for CPR. If you reach a trained operator, put your phone on speaker to hear the instructions; the operator will count out loud to help you administer compression at the correct rate (about 100 beats per minute). The AHA also has a Spotify playlist of 150 songs that have the right rate to guide chest compressions.

When Dr. Goldberg teaches CPR, the most common question he gets is "How do I know if someone actually needs CPR?" Unconscious people in cardiac arrest may gasp and grunt, which can be mistaken for breathing. "When in doubt, err on the side of caution and start chest compressions. People will stop you if they're okay," says Dr. Goldberg.

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