Cardiopulmonary resuscitation (CPR) is a life-saving sequence of actions designed to manually circulate blood and oxygen when a person’s heart or breathing has stopped. For infants—defined as those under one year of age—performing CPR correctly is especially time-sensitive to prevent permanent brain injury. The body of an infant is significantly different from that of a child or adult, making the specific techniques for effective resuscitation unique.
Compression Depth: The Specific Measurement and Goal
The specific measurement for infant chest compressions is approximately 1.5 inches, or about 4 centimeters. This depth is standardized because it represents roughly one-third of the infant’s total chest depth. Achieving this compression distance is necessary to squeeze the heart between the breastbone and the spine, which mimics the pumping action needed to move blood to the brain and other vital organs.
Compressing the chest less than this recommended depth will not generate enough blood flow to sustain life. However, pushing too deeply can lead to internal injuries, such as broken ribs or damage to the liver and lungs, underscoring the need for precise force. Between each compression, it is important to allow the chest to fully recoil back to its normal position, which allows the heart to refill with blood.
Proper Technique for Infant Chest Compressions
The most common technique for a single rescuer performing compressions on an infant involves using two fingers. The rescuer should place the tips of their index and middle fingers, or middle and ring fingers, on the center of the infant’s breastbone. This placement should be on the lower half of the sternum, just below an imaginary line drawn between the infant’s nipples, while avoiding the very bottom tip of the breastbone.
For two rescuers, the preferred method is the two-thumb encircling technique, which is often more effective at maintaining consistent depth and pressure. In this technique, the two thumbs are placed side-by-side on the compression area, with the remaining fingers wrapped around the infant’s back for support. Regardless of the method used, the rescuer must push straight down, ensuring the compression is smooth and consistent. The pressure should come from the rescuer’s upper body and shoulders, not solely from the arms, to maintain the correct depth over time.
The Rhythm of Resuscitation: Rate, Ratio, and Breaths
Compressions must be delivered at a rate of 100 to 120 compressions per minute to maximize blood circulation. This fast pace ensures a steady, albeit artificial, flow of blood and can be maintained by compressing to the rhythm of a song with an appropriate beat.
The compression-to-breath ratio varies depending on the number of people performing the resuscitation. For a single rescuer, the cycle involves 30 compressions followed by 2 rescue breaths, repeating this 30:2 pattern. If two rescuers are present, the ratio changes to 15 compressions followed by 2 breaths, which allows for more frequent ventilation due to the respiratory cause of most infant cardiac arrests.
Before delivering a breath, the rescuer must open the airway using a slight head tilt and chin lift, being careful not to hyperextend the neck. The rescue breaths must be delivered gently, using a mouth-to-mouth-and-nose seal, or a mouth-only seal if the nose is covered.
Each breath should last about one second, providing only enough volume to make the infant’s chest visibly rise. If the lone rescuer is not near a phone, they should perform two minutes of CPR—approximately five cycles of 30:2—before activating the emergency response system.