At a glance
Cardiopulmonary resuscitation (CPR) is an emergency treatment that manually keeps blood and oxygen moving through the body when the heart has stopped beating or is too weak to pump on its own. A rescuer alternates between pressing hard on the centre of the chest, which squeezes the heart and pushes blood forward, and giving rescue breaths that push air into the lungs. Together, these two actions buy time until the heart can be restarted.
When the heart stops, the brain begins to suffer damage within minutes from lack of oxygen. CPR slows that damage by maintaining a minimal flow of oxygenated blood to the brain and other vital organs. It is almost always a bridge to a definitive treatment, such as a controlled electric shock called defibrillation (a reset delivered by a machine that jolts the heart back into a normal rhythm), rather than a cure by itself.
Medical Condition
CPR is started when a person is unresponsive, not breathing normally, and has no detectable heartbeat. These are the signs of cardiac arrest (the sudden complete loss of the heart's pumping function), and every minute without CPR reduces the chance of survival.
- Sudden cardiac arrest from ventricular fibrillation (chaotic, ineffective quivering of the heart's lower chambers)
- Cardiac arrest caused by a heart attack that has blocked blood flow to the heart muscle
- Respiratory arrest (breathing stops before or alongside the heart), such as from drowning, choking, or drug overdose
- Cardiac arrest following a severe electric shock or lightning strike
- Cardiac arrest in the setting of severe trauma
- Newborn resuscitation when a baby is born not breathing or with a very slow heartbeat
CPR is not started, or is stopped, in certain situations. A person who has a valid Do Not Resuscitate (DNR) order, who shows clear signs that life has ended for some time (such as rigor mortis, the stiffening of muscles after death), or whose injury is so severe that survival is impossible would not receive CPR. The decision rests with the medical team present.
Risks & Complications
CPR is performed because the alternative, doing nothing, is certain death; any physical side effects are treated as acceptable consequences of a life-saving intervention.
- Fractured (broken) ribs, the most common physical consequence of effective chest compressions, especially in older adults with more brittle bones
- Fractured sternum (breastbone), which can occur from the same compression force
- Bruising or injury to the tissues of the chest wall
- Lung contusion (bruising of lung tissue) or, rarely, a pneumothorax (a collapsed lung caused by air leaking out of the lung into the chest cavity)
- Injury to the liver or other abdominal organs if compressions are placed too low on the chest
- Aspiration (inhaling stomach contents into the lungs) during rescue breathing
- Brain injury from the period of time without oxygen before and during CPR, which is a consequence of the underlying cardiac arrest rather than of the CPR itself
Preparation & Procedure
CPR is an emergency response, not a planned procedure. There is no fasting, no medication review, and no pre-procedure testing, because there is no time. The only preparation that matters is the speed at which someone starts CPR and calls for emergency help.
For healthcare teams working in a hospital setting, resuscitation equipment is kept ready at all times. A crash cart (a wheeled cabinet stocked with medications, a defibrillator, breathing tubes, and other resuscitation supplies) is positioned on each ward so it is never more than seconds away.
The sequence of events during CPR follows a recognised international framework called the chain of survival. The steps below reflect what typically happens when a medical team or a trained bystander responds.
- Step 1: Recognise that the person is unresponsive and not breathing normally, then shout for help and call emergency services.
- Step 2: Begin chest compressions immediately, pressing the heel of both hands onto the centre of the chest and pushing down firmly and fast.
- Step 3: If trained and willing, give rescue breaths after every set of compressions, tilting the head back to open the airway first.
- Step 4: Use an automated external defibrillator (AED, a portable machine that analyses heart rhythm and delivers a shock if needed) as soon as one is available.
- Step 5: Continue CPR and defibrillation cycles until advanced medical help arrives or takes over.
- Step 6: Advanced life support team takes over, placing a breathing tube, establishing intravenous (IV) access, and giving medications to try to restart the heart.
Aftercare
Patients who survive cardiac arrest after CPR require close monitoring and further treatment, usually in an intensive care unit (ICU). The focus shifts immediately to finding and treating whatever caused the heart to stop, protecting the brain from further damage, and managing any injuries that resulted from the resuscitation itself.
- ICU monitoring: continuous tracking of heart rhythm, blood pressure, oxygen levels, and brain function, often for several days
- Targeted temperature management: in some patients, doctors cool the body to a specific temperature for a period of hours to reduce brain injury, a technique sometimes called therapeutic hypothermia
- Investigation of the underlying cause: tests such as an EKG (electrocardiogram, a recording of the heart's electrical activity), blood tests, coronary angiography (an X-ray scan of the heart's arteries), or brain imaging may follow
- Treatment of the cause: this might include placement of a coronary stent (a small mesh tube to keep a blocked artery open), heart surgery, or other targeted therapies
- Chest wound care: rib or sternum fractures from compressions are monitored; they usually heal on their own but can cause pain that needs management
- Rehabilitation: survivors often need physical, cognitive (thinking and memory), and psychological support, sometimes over many months
- Follow-up cardiology appointments to review heart function and adjust long-term medications
- Discussion of implantable devices such as a pacemaker or an implantable cardioverter-defibrillator (ICD, a device placed under the skin that can shock the heart back into rhythm if it stops again)
Cost & What Determines It
The cost of care following a cardiac arrest and CPR varies enormously depending on what caused the heart to stop and how complex the recovery turns out to be. CPR itself takes minutes, but the hospital stay, investigations, and treatments that follow can stretch over days or weeks and involve many different specialists and technologies.
- Complexity of the underlying cause: a simple arrhythmia (irregular heartbeat) treated with medication costs far less than a blocked artery requiring emergency surgery or stenting
- Length of ICU stay: intensive care beds are among the most expensive in any hospital, and the number of days spent there drives much of the total bill
- Implantable devices: a pacemaker or ICD adds significant cost in both the device itself and the procedure to place it
- Advanced brain monitoring or cooling therapy, if used, adds specialised equipment costs
- Rehabilitation services: physical therapy, speech therapy, or neurological (brain and nerve) rehabilitation after brain injury can add weeks of additional care
- Hospital class and country: a private tertiary hospital in a high-income country charges very differently from a comparable facility elsewhere
- Medications given during and after resuscitation, including blood thinners, anti-arrhythmics (drugs that steady the heart's rhythm), and others, vary in cost by location
- Diagnostic imaging and laboratory tests ordered during the workup add to the total
Hospital packages for post-cardiac arrest care, where they exist, typically cover the ICU stay, nursing care, standard medications, and basic monitoring. Specialist consultations from cardiologists (heart doctors), neurologists (brain and nerve doctors), or intensivists (ICU specialists) are often billed separately, as are implantable devices, advanced imaging, and rehabilitation programs.
Indonesian patients travelling abroad for follow-up cardiac care should be aware that BPJS Kesehatan does not cover treatment outside Indonesia, and most domestic insurance policies do not either. Costs are typically paid out of pocket or through private international health insurance. Before travelling, ask the hospital for a written cost estimate that lists which services are included and which are charged separately; this is the most reliable way to avoid unexpected bills.
Frequently Asked Questions
How many CPR sessions will I need?
CPR is a single emergency intervention, not a course of repeated sessions. It is performed once, in the moment a person's heart or breathing stops, and continues until the heart restarts, professional help takes over, or the medical team makes another decision.
What does CPR feel like while it is happening?
A person receiving CPR is unconscious and does not feel the chest compressions during the procedure itself. Afterwards, if resuscitation is successful, some people notice chest soreness or rib tenderness, because the compressions needed to restart the heart are firm by necessity.
How soon will I know if CPR has worked?
The medical team can usually tell within minutes whether the heart has restarted, because they monitor the pulse and breathing continuously during and immediately after CPR. Full recovery, however, takes longer to assess, and doctors will run further checks, such as heart monitoring (EKG) and blood tests, once the patient is stable.
How much does CPR cost?
The cost depends on several factors: whether it is performed in an emergency room or intensive care unit (ICU), how long the resuscitation effort lasts, which additional equipment or procedures are used alongside it, and the class of hospital providing care. A written estimate from the hospital is the only reliable way to get a real number for your specific situation.
This page is general information, not a substitute for medical advice. Every case is different. Your doctor decides what is right for you.
