Is There Hope If, After Four Minutes of Rescue Breathing, No Pulse Can Be Found?

How Long Can CPR Take to Work?: Is There Hope If After Four Minutes of Rescue Breathing No Pulse Can Be Found?

Minutes can feel like hours when you are administering CPR in a real-life situation. Because of this, it’s helpful to know how long CPR takes to work. For example, if after four minutes of rescue breathing no pulse can be found, what do you do? 

The short answer is that the length of CPR that needs to be given varies from case to case. Sometimes CPR has been successful after a few short minutes; sometimes it takes much longer. Often, it’s not successful at all.

Here we look at examples of how long CPR has taken to work in real-life cases, and what you should do when CPR doesn’t appear to be working and after four minutes of rescue breathing, no pulse can be found. 

What Happens to the Vital Organs During Cardiac Arrest 

All organs need oxygen to function. The body starts to die when the heart, lungs, or brain stop functioning. Failure to resuscitate these organs leads to the failure of other organs around the body.

This process can be reversed with CPR, giving artificial restoration of the vital organs. This is a necessity when a victim suffers cardiac arrest or a heart attack. Without CPR, a person in cardiac arrest will quickly lose organ function because there is nothing to give oxygen to these organs. To see what happens during CPR, check out our infographic.

CPR can take time to work, which is why it is so important to begin CPR as soon as possible.

What Happens During the Initial Stages of CPR

The point of CPR is to return oxygen to the vital organs in the body. Prolonged oxygen deprivation impacts the brain. This begins to happen within three minutes of the heart stopping. The longer the brain is deprived of oxygen, the worse the damage to the organs will be. 

CPR is a manual way of getting blood flowing around the body. This means blood cells carrying oxygen will still reach the organs. It is a temporary fix, however, and the goal of CPR is to restart the heart to a return of spontaneous circulation (ROSC).

However, this does not mean that all is lost if after four minutes of rescue breathing no pulse can be found. If there is no pulse after four minutes of rescue breathing or CPR, there is a much-reduced chance of recovery, but recovery is still not impossible.

Examples of Successful CPR: Is There Hope If After Four Minutes of Rescue Breathing No Pulse Can Be Found?

When the heart stops, every moment counts, becoming a race against time. The body’s energy levels drop, and cells struggle to get oxygen. But even in this challenging situation, there’s a ray of hope — CPR. Even when it seems like there’s no pulse for four minutes, CPR can still make a difference. 

There are stories of people whose hearts stopped but were brought back to life by CPR. Read on to learn a couple of these stories to remind us of the power of human resilience and the importance of never giving up. 

The Crossfitter

In the local neighborhood gym, where clanging weights and the bustling energy of fitness enthusiasts fill the air, a man in his 30s throws himself into his CrossFit routine with determination. Tire flips, kettlebell swings, and intense cardio intervals are all part of his rigorous regimen.

Midway through his workout, he feels a sudden twinge of discomfort in his chest as he reaches for a heavy weight. Ignoring the warning signs, he chalks it up to the strain of the workout, assuming it’s just a pulled muscle.

However, moments later, as he attempts another lift, a searing pain radiates through his chest, causing him to stumble and collapse onto the gym floor. Panic ripples through the once lively space as fellow gym-goers rush to his aid, realizing the gravity of the situation.

In the blink of an eye, he goes from being an active participant in his workout to lying unconscious, his body betraying him in a moment of crisis. Bystanders spring into action, some dialing emergency services while others fetch the gym’s automated external defibrillator (AED).

Meanwhile, as precious minutes tick by, his heart tissue begins to die from lack of oxygen, descending into necrosis with each passing moment. Without intervention, the chances of survival plummet, emphasizing the critical importance of restoring blood flow to his heart.

When the AED arrives, there’s a collective breath of hope as it’s swiftly applied to his chest. Electricity surges through his inert body, a last-ditch effort to restore normal rhythm to his faltering heart. But despite the shock, his heart remains stubbornly silent, trapped in a dangerous rhythm that defies intervention.

Time becomes both an ally and a foe as the battle for his life unfolds. With each passing moment, the threat of irreversible damage looms larger, his body starved of oxygen as his heart struggles to find its rhythm once more.

Finally, a faint pulse gets detected after what feels like an eternity. Yet, even as his heart stutters back to life, he fails to come back to consciousness. And so, with the urgent wail of ambulance sirens, he is whisked away to the sanctuary of the hospital, his life now in the hands of skilled medical professionals.

The Swimmer

A woman in her 60s indulges in her beloved routine of swimming laps in the pool of her local gym. Wednesdays and Fridays are her sanctuary, a time to escape the hustle and bustle of everyday life and find peace in the rhythmic strokes of her swim.

Yet, a silent crisis unfolds within her body. Unbeknownst to her fellow swimmers, her heart weakens, its rhythm slowing to a dangerous pace known as pulseless electrical activity (PEA). Despite her efforts to keep her head above water, the subtle signs of distress go unnoticed.

Luckily, a vigilant swimmer notices the subtle changes in her demeanor. Sensing something wrong, they spring into action, urgently signaling for help while carefully maneuvering her out of the pool and onto a nearby backboard. With a sense of urgency, they initiate rescue measures, knowing that every second counts in the fight for her life.

As one person calls 911, another takes charge of providing support on the backboard. They lean over her, their hands steady as they begin the critical task of rescue breathing. With each breath, they work hard to fill her lungs with life-giving oxygen.

In the absence of CPR training, rescue breathing becomes their sole focus until a health professional or CPR-certified individual arrives on the scene. With a collective sigh of relief, they watch as the ambulance pulls up and the paramedics take over — knowing that their awareness and quick thinking saved a life.

When CPR Has Worked After Five Minutes

Vital organs will start to be affected after just minutes of being deprived of oxygen. If there is still no pulse after four minutes of rescue breaths, the advice is to keep going.

While chances of survival decrease with every minute that passes, there have been many success stories in which giving CPR for much longer than five minutes has saved a life.

When it comes to giving CPR, though, every minute counts. This downloadable PDF has all the information you need to understand its importance. 

When CPR Has Worked After 20 Minutes

Some medical bodies, such as the National Association of Emergency Medical Services Physicians, suggest at least 20 minutes of CPR should be given to people experiencing an out-of-hospital cardiac arrest. 

While the survival rate in out-of-hospital cardiac arrests where CPR was given for 20 minutes or more is still only 5%, one study showed “multiple cases of survival” after 20 minutes or more of resuscitation.

When CPR Has Worked After 90 Minutes

One study showed a 48-year-old man survived an in-hospital cardiac arrest that lasted around one and a half hours. Many would consider this to be impossible, but he is proof otherwise.

The man received CPR for 90 minutes, and seven days later had full neurological recovery.

When CPR Has Worked After Much Longer Periods

Of course, in exceptional cases, survival seems almost miraculous.

In 2019 a study presented a 52-year-old Italian mountaineer who had survived cardiac arrest with complete organ recovery after receiving CPR for 5 hours and 44 minutes. This is relatively unheard of, but shows that CPR truly matters.

When to Stop Giving CPR

There is no prescribed “stopping” time when giving CPR. Success rates are on a case-by-case basis. We go into more depth on this in our article, “How Long Should You Continue CPR?.”

It is generally recommended to perform CPR continuously for at least two minutes before assessing a patient’s response. Even if you do not observe a response, continue CPR until help arrives.

What to Do When CPR Does Not Work

Sadly, CPR does not always work. CPR isn’t keeping someone alive, it is buying time until other help arrives.

There is no medically-defined time to stop CPR. If after four minutes of rescue breathing there is still no pulse, continue giving CPR until help arrives. Our minute-by-minute guide to what happens during CPR explains this further.

It is true that chances diminish with each minute that passes. If after four minutes of rescue breathing no pulse is detectable, the chances of recovery without a brain injury are low. Still, it is worth trying in the hope that the victim may survive. As a giver of CPR, you will not always be able to save a life, but by continuing to administer CPR until emergency aid arrives, you can know that you did everything you could.

Performing CPR consistently until a medical team can take over may give enough oxygen to the brain, heart and lungs to mean full recovery for the patient. It is those initial few minutes of CPR that are vital for a chance of recovery.

We can coach your staff in the basics of CPR so they can administer effective and safe aid when needed. Contact us today to learn more.