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After the shock: two-minute cycles and signs of life
What the rhythm of a resuscitation actually looks like once the machine is running, what return of circulation looks like from the outside, and what to do in the minutes between that and the ambulance.
CPR in sixty seconds
- Unresponsive and not breathing normally? Gasping is not breathing. Treat it as a cardiac arrest.
- Call 112 (113 in Norway). Speaker on, phone on the floor. Stay on the line — the dispatcher will coach you.
- Push hard and fast in the centre of the chest: 5–6 cm in an adult, 100–120 per minute, letting the chest come all the way back up.
- Send somebody else for a defibrillator. Do not go yourself unless it is seconds away. Keep compressing.
- Turn the device on and do what it says. It decides whether to shock. After a shock, go straight back to compressions.
This is a reference written for bystanders, not a diagnosis, a training course or medical advice. It cannot tell you what is wrong with a particular person, and it does not replace the dispatcher on the other end of an emergency call — they can see what is near you and they will talk you through it. If you are worried about your own heart, or about a symptom, that is a conversation with a clinician rather than a page on a website.
The loop you are now in
Once pads are on, the resuscitation settles into a repeating two-minute cycle: analyse, shock or not, then two minutes of uninterrupted compressions, then analyse again. Everything else fits around it — the rescuer changeover, the airway, the arriving responders. Your job between analyses is unglamorous and decisive: keep the rate at 100 to 120, keep the depth at 5 to 6 centimetres, and keep the pauses under five seconds. Interruption time is one of the few things a bystander controls that clearly changes outcome.
Do not stop to check whether it worked
The instinct after a shock is to sit back and look for a response. Guidelines specifically remove that step: resume compressions immediately, without a pulse check, because a heart that has just been defibrillated is usually stunned and needs the circulation you provide. If it has genuinely restarted, you will find out anyway — the patient will start to resist you, and that is unmistakable.
What return of circulation looks like from the outside
Purposeful movement. Coughing or swallowing. Eyes opening. Colour returning to the face. Above all, breathing that is regular and quiet rather than the gasping you heard at the start. One of these on its own during compressions is a reason to pause and look for no more than ten seconds; several together mean stop compressing and reassess. A single twitch is not enough — bystander compressions frequently make an unresponsive person twitch.
If they start breathing normally
Stop compressions, leave the defibrillator pads on and the unit switched on, and roll the person into the recovery position on their side with the head tilted back so the airway stays open and vomit can drain. Stay with them and keep watching the chest, because re-arrest in the first minutes is common: if the breathing stops or becomes gasping again, roll them flat and restart compressions immediately. Tell the dispatcher what has happened — they will change the ambulance response.
Between recovery and the ambulance
Keep them warm, keep them still, and do not give anything to eat or drink. Someone who has just been resuscitated may be confused, combative or frightened and will remember nothing; speak calmly and do not let them get up and walk. If the arrest was witnessed and defibrillated quickly the person may look almost normal within minutes, which is exactly when people stand down too early. Every resuscitated patient goes to hospital, without exception.
Sources: European Resuscitation Council Guidelines · Käypä hoito national guideline: Elvytys · checked 2026-09-08
Frequently asked questions
How long do we keep going?
Until the ambulance crew takes over, until the person is definitely breathing normally, or until you physically cannot continue. Bystanders are not asked to make a decision to stop.
They started breathing — do I take the pads off?
No. Leave the pads on and the device running, put the person on their side, and keep watching. Re-arrest within minutes is common and the machine is already attached if it happens.
Should the person walk to the ambulance if they seem fine?
No. Anyone resuscitated from a cardiac arrest is transported, however well they look. Keep them lying down and warm until the crew decides how to move them.
What to do, right now
Is this a cardiac arrest?
Two checks decide it: not responding, and not breathing normally. The noisy gasping that fools nearly everyone, why a brief seizure at the start is a cardiac sign, and why a heart attack is a different emergency.
Hands-only CPR, in sixty seconds
Centre of the chest, 100 to 120 pushes a minute, 5 to 6 cm deep, let the chest come all the way back up, and do not stop. The rate, the depth, the fatigue problem, and a pacer that keeps you on the beat.
The emergency call, and the address problem
What the dispatcher asks, why the phone goes on speaker on the floor, how dispatcher-guided CPR works, and the single hardest question in a rural arrest: where exactly are you?
Using a defibrillator, step by step
Open it, turn it on, bare the chest, follow the voice. What the machine decides for you, what it will never do, and the one instruction people get wrong — go straight back to compressions after the shock.
Where the pads go, and what gets in the way
Right collarbone and left ribs, or front and back. Chest hair, sweat, snow, a medicine patch, a pacemaker lump, an underwired bra, a tattoo: which of these actually matter and what to do about each.
Everything on this subject
Before the emergency, there is a long quiet stretch
Blood pressure, resting heart rate, movement and sleep are the part of this you can act on for years beforehand. TempoLife keeps them in one place, free to start.