Where Should You Place the Heel of Your Hand When Performing Chest Compressions on an Adult: The Exact Spot, Landmarks, and Depth Science

Place the heel of your hand on the lower half of the adult victim's breastbone (sternum), in the center of the chest — never on the ribs, never at the bottom tip of the sternum, and never over the upper abdomen. Landmark it by sliding two fingers up the lower rib cage to the notch where the ribs meet the breastbone, then put the heel of your hand on the sternum immediately above that notch. This single position, pressed at least 2 inches deep at 100 to 120 compressions per minute, is the difference between circulating blood to the brain and causing a preventable injury.

The anatomy that dictates hand placement

The sternum is a flat vertical bone roughly 6 to 8 inches long in adults, running down the front center of the chest. Behind it sit the right ventricle, the left ventricle, and the great vessels — structures you can physically squeeze against the spine when you compress. That squeeze is the entire mechanism of cardiopulmonary resuscitation (CPR): you are not restarting the heart directly, you are acting as a temporary pump that moves oxygenated blood to the brain and coronary arteries.

The lower half of the sternum is where the ventricles lie, which makes it the highest-yield compression point. The upper half sits over the great vessels and offers less ventricular squeeze. The very bottom tip of the sternum, called the xiphoid process, is a small cartilaginous projection that can break off under pressure and lacerate the liver. Pressing below it compresses the liver and stomach instead of the heart — an ineffective and dangerous placement. One plain-language way to hold this: aim for the middle of the chest, then shift slightly toward the feet, staying on bone.

The ribs flare outward and downward on both sides. A hand placed too far left lands on ribs and can fracture them without generating good cardiac output. A hand placed too far right is equally off-target. The breastbone is your target because it is the only structure that transmits force efficiently to the ventricles while distributing it across a broad bone surface.

Quantified context: why the numbers matter as much as the spot

Guideline-based CPR couples hand position with rate and depth, and the numbers are tightly specified. The American Heart Association recommends compressions at 100 to 120 per minute and at least 2 inches (5 cm) deep for an average adult, but no more than 2.4 inches (6 cm). Push faster or shallower and cardiac output falls short; push deeper and you raise fracture risk without proportional benefit.

Hand placement changes the physics of force delivery. Compressing directly over the lower sternum with the heel of one hand (and the second hand stacked on top) concentrates force through a stiff bone plate. Compressing off-center over ribs diffuses that force through curved, flexible structures that absorb energy instead of transmitting it to the heart. The result is lower stroke volume per compression — the volume of blood ejected with each push.

Recoil matters too. Full chest recoil between compressions lets the chest expand and the heart refill, and leaning on the chest between pushes reduces filling and output. The heel of your hand stays in contact, but your weight should come off completely each cycle. A compression fraction — the proportion of resuscitation time spent actively compressing — above 60 percent is the practical target, and hand position that slips forces repositioning pauses that cut into that fraction.

Edge cases that shift the landmark

Not every adult chest looks the same, and the landmarking method adapts. In a person with obesity, the sternum may sit deeper beneath soft tissue; you still find it by tracing the rib margin, not by estimating from the surface. In a person who is very thin, the bony landmarks are prominent and easy to confirm by touch. In pregnancy, the chest anatomy is unchanged — compress the same lower-sternum spot, though you may need to adjust the victim's position (such as slight left lateral tilt in late pregnancy) so the uterus does not compress the inferior vena cava and impede blood return.

Chest shape after surgery is a genuine edge case. A person with a median sternotomy scar, a sternal wire, or a recent cardiac surgery may have a sternum that is mechanically compromised. You still compress the lower sternum, because the alternative — not compressing — guarantees no circulation. The professional caveat here is counterintuitive: a sternal fracture sustained during CPR is a common and generally acceptable complication, and it is not a reason to stop compressions. Rib and sternal fractures occur in a meaningful share of resuscitations, and survival depends more on sustained perfusion than on an intact chest wall.

Another edge: a person with a pacemaker or implanted defibrillator has a device pocket, usually in the upper chest below the collarbone. That device sits away from the lower sternum, so standard placement avoids it. Avoid pressing directly on a visible device pocket, but do not let it distract you from correct lower-sternum placement.

Misconceptions about hand placement

The most persistent myth is that you should place your hands "on the heart," which people visualize as far left on the chest. The heart sits mostly behind the sternum, slightly left of midline, so the center of the chest over the lower sternum already sits over the ventricles. Chasing the heart leftward puts you on ribs.

A second myth is that the second hand must interlock fingers in a specific ceremonial grip. The stacked-hand technique matters for force transmission and for keeping fingers off the ribs, but the essential element is the heel of the lower hand on the lower sternum with fingers lifted. Interlacing is a technique detail, not the placement itself.

A third misconception is that a smaller rescuer cannot compress adequately. Depth comes from body weight and positioning — shoulders stacked over the hands, arms straight, using the torso — not from hand strength. A rescuer who leans over the victim and drives with the upper body can reach adequate depth regardless of arm strength.

A fourth is that you should "feel for the heartbeat" or check a pulse repeatedly before or during compressions. In a pulseless adult, compressions should begin immediately and continue with minimal interruption; prolonged pulse checks waste perfusion time. One more: some people believe compressions must wait for a defibrillator. High-quality compressions and early defibrillation work together, and compressions should not be delayed while equipment is fetched if you can start now.

Practical actions and thresholds

Confirm the victim is unresponsive and not breathing normally, then call emergency services or direct someone to call and to fetch an automated external defibrillator (AED). Expose the chest if practical, then place the heel of one hand on the center of the chest over the lower half of the sternum. Stack the second hand on top, interlace or lift fingers so they do not press the ribs, and keep arms straight with shoulders over your hands. Compress at 100 to 120 per minute to a depth of at least 2 inches but no more than 2.4 inches, allowing full recoil each time. Minimize interruptions: keep hands on the chest during rhythm checks and switch compressors about every 2 minutes to limit fatigue. Use the AED as soon as it arrives and follow its voice prompts; resume compressions immediately after any shock.

Red-flag warnings: do not compress over the xiphoid tip or the upper abdomen; do not press on ribs, on the device pocket of an implanted defibrillator, or on a visible wound; do not lean on the chest between compressions; do not stop compressions to search for a pulse at length; and do not delay compressions to look for equipment you can send someone else to retrieve.

Limitations of what this guidance can settle

This guidance describes the standard adult technique taught by major resuscitation bodies; it cannot account for every anatomical variation, and it does not replace hands-on training with a certified instructor and a compression-feedback manikin. The depth thresholds cited are guideline targets, not guarantees of outcome, and survival after out-of-hospital cardiac arrest depends heavily on time to compressions, time to defibrillation, and the underlying cause. Bystander CPR with correct placement and depth improves the chance of survival, but it does not promise it. If you have not been trained, follow dispatcher instructions and start compression-only CPR — a slightly imperfect hand position delivered immediately beats a perfect position delivered late.

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This article is general educational information about CPR technique, not a diagnosis, treatment plan, or substitute for certified training. It does not promise any outcome, and individual circumstances vary. For immediate danger or a suspected cardiac arrest, call your local emergency services and follow dispatcher instructions; seek hands-on training from a qualified local instructor or your national resuscitation council.