Cardiopulmonary resuscitation (CPR) for infants and children is an emergency procedure that can improve survival during cardiac arrest. It involves actions to circulate oxygen-rich blood to the brain and other vital organs when the heart has stopped pumping. Correctly applying pediatric CPR techniques, including proper timing and depth, is essential for its effectiveness.
Compression Timing and Depth: The Core
Chest compression timing in pediatric CPR is defined by a specific rate, not individual compression duration. Current guidelines recommend a rate of 100 to 120 compressions per minute for both infants and children. This consistent pace ensures continuous blood flow to vital organs. Maintaining this rhythm is important; pushing too fast can compromise depth, and pushing too slowly may not provide adequate circulation.
Compression depth is important and varies between infants and children due to their differing body sizes. For infants, under one year of age, compressions should depress the chest by about 1.5 inches (4 cm). For children, from one year of age until puberty, the compression depth should be approximately 2 inches (5 cm). These depths correspond to at least one-third of the anterior-posterior diameter of the chest.
Allowing the chest to fully recoil after each compression is important for effective CPR. Full recoil permits the heart to refill with blood, necessary for the next compression to effectively circulate blood. Insufficient recoil can reduce the amount of blood pumped with each compression, reducing CPR effectiveness.
Beyond Compressions: Essential CPR Techniques
Beyond the rate and depth of compressions, proper hand placement and the integration of rescue breaths are important for effective pediatric CPR. For infants, compressions are typically performed using two fingers placed on the sternum just below the nipple line. Alternatively, the two-thumb-encircling hands technique can be used, especially by two rescuers. For children, rescuers can use the heel of one hand or two hands, depending on the child’s size, placed over the lower half of the breastbone.
Rescue breaths are an important component of pediatric CPR, as cardiac arrest in children often stems from respiratory issues. For a single rescuer, the recommended compression-to-ventilation ratio is 30 compressions followed by two rescue breaths. If two rescuers are present, the ratio shifts to 15 compressions to two breaths. Each rescue breath should last about one second, with visible chest rise.
Minimizing interruptions to chest compressions is important for CPR outcomes. Pauses should be kept as brief as possible. Continuous, high-quality compressions maintain consistent blood flow to the brain and other vital organs, buying time until medical help arrives.
Recognizing the Need and What Comes Next
Recognizing the signs that necessitate pediatric CPR is the first step in providing life-saving intervention. CPR should be initiated if an infant or child is unresponsive and not breathing normally, or is only gasping. Unresponsiveness means the child does not react to stimulation. Abnormal breathing may appear as gasping or irregular, shallow breaths, not to be mistaken for normal breathing.
Once CPR is needed, activate emergency medical services (EMS) and continue CPR without interruption. If alone and the cardiac arrest was not witnessed, perform about two minutes of CPR before calling 911. If the collapse was witnessed, or if another person is present, one person should call for help while the other begins CPR.
CPR should be continued until medical help arrives, or until the child shows signs of recovery, such as normal breathing or movement. CPR maintains vital functions, providing the best chance for survival. Formal CPR training is recommended for anyone who might help a child in an emergency.