Cardio-pulmonary arrest is a combination of two life-threatening conditions: absence of breathing and lack of an effective heartbeat.

Major causes of cardio-pulmonary arrest in adults include: heart disease, trauma, excessive bleeding, drug overdose, and sepsis.

• Unconsciousness
• No breathing
• No pulse

1. Check for consciousness. Shake or tap the victim gently. See if the victim moves or makes a noise. Shout, "Are you OK?"
   
   
2. If there is no response, shout for help, immediately call the local emergency number, then continue CPR. If someone else nearby can help, have one person call the local emergency number immediately, while the other performs CPR.
   
   
3. Position the victim on his or her back on a hard, flat surface, keeping the back in a straight line, supporting the head and neck. Loosen the victim's clothing, if necessary, and expose victim's chest.
   
   
4. Kneel next to the victim. Tilt the victim's head back and lift the jaw forward to move the tongue away from the windpipe. If a spinal injury is suspected, do not tilt the head back, but instead open the airway by putting 2 or 3 fingers under each side of the lower jaw and lifting upward. Do not let the victim's mouth close.
   
   
5. Place your ear close to the victim's mouth, and watch for chest movement. Look, listen, and feel for breathing for up to 10 seconds.
   
   
6. If the victim is breathing, place him or her in the recovery position (see unconsciousness).
   
   
7. If the victim is not breathing, begin rescue breaths. Maintain the head position, close the victim's nostrils by pinching them with your thumb and index finger, and cover the victim's mouth tightly with your mouth. Give 2 slow, full breaths, lasting 2 seconds each, with a pause in between.
   
   
8. If the chest does not rise, reposition the head or jaw, and give 2 more breaths. If the chest still doesn't rise, the victim's airway may be blocked. Follow instructions for choking (for unconscious adult or child over 1 year).
   
   
9. If the chest rises, non-medical rescuers should reassess the victim for signs of circulation (spontaneous breathing, coughing, or movement) and if still absent, should begin chest compressions. (Trained health care providers should assess for the presence of a pulse before beginning chest compressions.)
   
   
10. If the victim has evidence of circulation, but is not breathing effectively on his or her own, continue to give 1 rescue breath every 5 seconds (about 12 breaths per minute) for as long as needed.
    
    
11. If chest compressions are necessary, maintain the victim's head position and place the heel of your hand 2 finger-widths above the lowest notch of the victim's breastbone (where the lower edge of the ribcage meets in the middle). Place the heel of your other hand directly over the heel of the first hand. Interlock your fingers -- don't let them touch the victim's chest. Lock your elbows straight. Lean your shoulders over your hands, and firmly press down about 2 inches into the victim's chest. Repeat the compressions 15 times. Give the compressions in a smooth, rhythmic manner, keeping your hands on the victim's chest. Don't rock back and forth - push straight down. Don't pause between compressions.
    
    
12. Give the victim 2 breaths, followed by 15 chest compressions. Repeat this sequence 4 times. Count aloud as you pump in a regular rhythm. You should pump at a rate of about 80 to 100 times a minute.
    
    
13. Re-check the victim for signs of circulation.
    
    
14. Repeat steps 12 and 13 until signs of circulation resume or help arrives. If signs of circulation resume, go to step 10.
    
    
15. If the victim starts breathing again spontaneously, place him or her in the recovery position, and periodically re-check for breathing and signs of circulation until help arrives.

• DO NOT give chest compressions if there is a pulse -- doing so may cause the heart to stop beating.
• DO NOT move the victim's head or neck to check for breathing if a spinal injury is suspected.

• If you are not alone, have one person call the local emergency number while another person begins CPR.
• If you are alone, as soon as you have determined that the victim is unresponsive, call the local emergency number immediately. Then begin CPR.

• Eliminate or reduce risk factors that contribute to heart disease, such as cigarette smoking, high cholesterol, high blood pressure, obesity, and stress.
• Get plenty of exercise.
• See your doctor regularly.
• Always use seatbelts and drive safely.
• Avoid illicit drugs.