The heart is compressed with one or both hands (preferably both) at a rate of 60 to 70 times a minute. Lungs are easily inflatable through a tube (endotracheal tube) inserted before the surgery or in the emergency department. Several individuals are needed to perform compressions in rotation to prevent hand fatigue. At the same time, drugs are administrated directly into the heart or intravenously. One or more attempts are made to defibrillate the heart with sterile paddles applied directly to the heart. The amount of electrical energy delivered via the paddles is much less than the amount delivered when the paddles are placed on the chest wall to deliver the electrical shock. If the cardiac arrest occurs in the recovery room or later in the surgical ward, the chest is reopened through the original incision. If the arrest occurs in the emergency department, the incision is made between ribs five and six on the side of the chest, and the ribs are spread apart.