Cardiopulmonary Resuscitation: Why It Matters to Start — and Why Doing Nothing Is Worse

When a person suddenly collapses, the most important factors are not experience or equipment, but the first quick and correct steps. In sudden cardiac arrest, survival does not depend only on how fast emergency services arrive, but on what happens in the minutes before they get there. CPR is not reserved for professionals, nor does it require special equipment. In the hands of a layperson, it is a simple and logical procedure aimed at maintaining at least minimal blood flow to the brain and buying time so that professional care has something to build on.

In this article, you will find clear decision points (when to start), common barriers that prevent people from acting, and a concise overview of how to perform CPR.

⚠️ The key message is simple: in most cases, doing nothing is worse than doing something imperfectly.

What Happens During Cardiac Arrest

In cardiac arrest, the heart stops pumping blood effectively. As a result, blood flow to the brain and other vital organs stops or becomes critically reduced. Without rapid intervention, the body quickly enters a state that has little chance of a good outcome.

The brain is the most vulnerable organ. Without adequate oxygenated blood, irreversible brain injury typically begins within 4–5 minutes. Emergency medical services often arrive later than that. If nothing happens in the meantime, the chances of survival — and of returning to a meaningful quality of life — rapidly decline.

It is essential to understand one thing:

A person who has collapsed and
👉 does not respond (to voice, shaking, or painful stimulus),
👉 and is not breathing normally

is not “just unconscious.” They are in immediate, life-threatening danger.

In the field, in winter or outside civilization, the arrival time of emergency services can take long minutes. First aid and the ability to start resuscitation are not "extra", but a basic part of responsibility.

CPR in Practice: Benefits and Limitations

CPR is not a cure, nor does it “restart” the heart on its own. However, in layperson resuscitation, it has clearly defined benefits and limits.

✅ What CPR Does

• Maintains at least minimal blood circulation through chest compressions
• Slows damage to the brain and other vital organs
• Significantly increases the chance that defibrillation and advanced care will succeed
• Buys critical time without which further intervention may be futile

🚫 What CPR Does Not Do

• It does not treat the underlying cause of cardiac arrest
• It does not reliably restore a normal heart rhythm
• It is not a substitute for defibrillation or advanced medical care

Without early CPR, even the best equipment and the fastest ambulance response may not be enough.

Simply put: CPR alone often does not solve the problem — but without it, the problem usually cannot be solved at all.

Why Calling for Help Is Not Enough

Calling emergency services (in many European countries, 112 or 155) is an essential first step. But a phone call cannot replace blood circulation.

If chest compressions are not being performed, blood does not circulate, the brain does not receive oxygen, and survival chances drop with every passing minute.

This is why emergency dispatchers will typically guide callers to begin CPR immediately. Perfect technique is not the priority. Starting quickly and minimizing interruptions in chest compressions is.

Why People Hesitate to Act

When faced with sudden collapse, most bystanders share similar concerns:

• Fear of doing something wrong
• Fear of causing harm (such as breaking ribs)
• Uncertainty about whether it is truly cardiac arrest
• Concern about potential legal consequences

These fears are natural and understandable.

However, in a person who is unresponsive and not breathing normally, the issue is not comfort or technical perfection. The issue is time until brain injury.

⚠️ In this situation, the greatest risk is not imperfect CPR. The greatest risk is that nothing happens.

The Critical Factor in Layperson CPR: Breathing Assessment

Public awareness materials often oversimplify CPR. In doing so, they sometimes omit the most crucial element: assessing breathing.

🔴 Check Breathing — This Is the Key Decision Point

For a layperson, the decision is actually simple. After a collapse and loss of consciousness, there are only two possibilities:

Either you see normal, regular breathing — or you do not.

The second category includes not only complete absence of breathing, but also irregular, very slow, or occasional gasping breaths.

🔴 Agonal Gasping Is Not Normal Breathing

This is a common source of confusion. At the onset of cardiac arrest, agonal gasps may occur — brief, irregular, reflexive inhalations that may look like signs of life to an untrained observer.

They are not effective breathing. Agonal gasping is a sign of severe circulatory failure and a clear indication to start CPR immediately — not a reason to wait.

🔴 Do Not Check for a Pulse

Do not waste time searching for a pulse. Under stress, people often feel their own pulse in their fingertips and mistakenly believe they have detected one. This leads to dangerous delays.

⚠️ To decide whether to begin CPR, you need only two facts:
The person is unresponsive
and not breathing normally.

In an environment out of reach of quick assistance, preparedness is key. Equally important as the equipment are the knowledge and the ability to make quick decisions – for example, starting resuscitation without unnecessary hesitation.

When to Start CPR

Assessment does not need to be complex or diagnostic. The layperson algorithm is intentionally simple to prevent hesitation.

✅ Start CPR if the person:

• Does not respond to voice or gentle shaking
• Is not breathing normally (no breathing, irregular breathing, or agonal gasps)

Unresponsiveness alone does not automatically require CPR. A deeply sleeping or intoxicated person may not respond but will breathe normally. In such cases, monitor breathing closely.

However, if you are unsure whether breathing is normal, treat the situation as cardiac arrest.

When in doubt, act.

Basic Step-by-Step Approach

The goal is not to memorize fine details, but to move quickly to what matters most.

1️⃣ Ensure safety — yours and the scene’s.

2️⃣ Check responsiveness — speak to the person and gently shake them.

3️⃣ Open the airway — tilt the head back and lift the chin.

4️⃣ Assess breathing — look, listen, and feel briefly for normal breathing.

5️⃣ Call emergency services — use speaker mode and follow dispatcher instructions.

6️⃣ Begin chest compressions:

• Place your hands in the center of the chest
• Compress at a rate of approximately 100–120 per minute
• Push to a depth of about 5–6 cm (2–2.5 inches)
• Allow full chest recoil after each compression
• Minimize interruptions

If an automated external defibrillator (AED) is available, use it as soon as possible. The device will guide you step by step. The key principle is to keep interruptions in compressions as short as possible.

Rescue Breathing: Part of CPR? Yes — But Not Always

In recent years, “hands-only CPR” (chest compressions without rescue breaths) has been widely promoted in layperson first aid. This approach makes sense: it simplifies the process, reduces hesitation, and minimizes delays.

However, rescue breathing has not disappeared from CPR. Its importance depends on the situation.

In adults with sudden cardiac arrest, rapid chest compressions are the priority. In the first minutes, the blood typically still contains some oxygen. The main problem is circulation, not immediate oxygen depletion.

✅ Rescue breaths may be beneficial if:

• You are trained and confident in the technique
• You can deliver two breaths with minimal interruption (ideally under 10 seconds)
• It is safe and acceptable for you to perform them

Blood, vomit, infection risk, or psychological barriers are legitimate reasons to omit rescue breaths.

⚠️ However, rescue breathing is especially important in:

• Children
• Drowning victims
• Airway obstruction leading to unconsciousness
• Other situations where oxygen deprivation is the primary problem

In these cases, the issue is not primarily cardiac failure, but lack of oxygen. A 30:2 compression-to-ventilation ratio may significantly improve survival — provided pauses are brief.

Across all scenarios, one rule applies:

If you do not give breaths, it is acceptable.
If you do not give compressions, it is a problem.

Be Careful with Automatic “Recovery Position” After Collapse

The recovery position has its place in first aid. However, after sudden collapse, it can be problematic if it leads to reduced monitoring.

If a person is unresponsive but breathing normally, the solution is not to place them on their side and walk away. Continuous monitoring — especially of breathing — is essential.

Breathing may deteriorate quickly after collapse. Normal breathing can turn into agonal gasps or stop entirely.

If that happens, CPR must begin immediately.

The biggest mistake is not choosing the wrong position — it is losing track of whether the person is still breathing normally.

Basic medical equipment by itself does not save lives, but in a crisis situation, it helps create conditions for effective first aid. Timely reaction and correct procedure are always crucial.

CPR in Remote or Delayed-Response Environments

In remote environments — mountains, forests, training areas, shooting ranges, or worksites — ambulance response times may be significantly prolonged.

In such settings, first aid is not an optional extra. It is part of essential preparedness, just like navigation tools or medical kits.

CPR is an extreme scenario no one expects. But when it happens, there is no time to look up instructions or debate ideal solutions.

In remote environments, rescuer safety and sustainability must also be considered. CPR is not performed “to total exhaustion at any cost,” but in a way that preserves the rescuer’s ability to maintain safety, seek help, or evacuate.

Early CPR in these conditions can mean the difference between a remaining chance and none at all — but it must be balanced with situational awareness and self-preservation.

Conclusion: A Decision That Buys Time

When someone is unresponsive and not breathing normally, perfection is not the goal. Action is.

CPR is not a guarantee of survival. But in the first critical minutes, it is the only way to maintain a real chance.

Starting CPR does not make you a healthcare professional. It means taking simple, meaningful steps: maintaining circulation, slowing brain injury, and buying time for advanced care.

Without that bridge, even rapid emergency response may have nothing to build upon.

The decision to begin CPR is not about courage or technical mastery.

It is a practical choice between doing something — and doing nothing.

And in those critical minutes, that choice can mean the difference between a chance — and losing it entirely.