Cardiopulmonary Resuscitation (CPR) for infants is a lifesaving intervention used when a baby is unresponsive and not breathing normally. The two-rescuer scenario is the standard protocol for trained healthcare providers or whenever a second trained person is available. This collaborative approach significantly improves the quality of resuscitation efforts by allowing one person to focus entirely on chest compressions and the other on ventilations. A second rescuer minimizes interruptions in blood flow and maximizes oxygen delivery, increasing the chance of a positive outcome.
The Standard Ratio for Two-Rescuer Infant CPR
Guidelines established by organizations like the American Heart Association (AHA) mandate a specific compression-to-ventilation ratio for two-rescuer infant CPR. When two trained rescuers are present, the cycle consists of 15 chest compressions followed by 2 rescue breaths, commonly referred to as the 15:2 ratio. This ratio is maintained continuously until the infant shows signs of recovery or until advanced medical help takes over.
The rescuer performing compressions must maintain a rapid rate of 100 to 120 compressions per minute. The second rescuer is responsible for delivering the two rescue breaths, ensuring each breath causes the infant’s chest to visibly rise. Rescuers should plan to switch roles approximately every two minutes, or after about ten cycles, to prevent fatigue and maintain the quality of the compressions.
Compression Technique for Infants
The preferred technique for delivering chest compressions in a two-rescuer setting is the “thumb-encircling hands” method. This involves the rescuer wrapping their hands around the infant’s torso, placing both thumbs on the center of the breastbone, just below the nipple line. The fingers support the infant’s back, stabilizing the body during compressions.
The goal is to compress the infant’s chest to a depth of approximately one-third the diameter of the chest, which translates to about 1.5 inches (4 cm) for most infants. This depth generates enough pressure to circulate blood to the vital organs. After each compression, the rescuer must allow the chest to recoil completely to its normal position. Full chest recoil ensures the heart refills with blood, maintaining effective circulation.
Single Rescuer vs. Two Rescuer Ratios
The distinct compression-to-ventilation ratios stem from the cause of cardiac arrest in infants. Unlike adults, who often arrest due to a primary heart problem, infants typically arrest secondary to respiratory failure or shock. Therefore, infants have a greater need for frequent ventilations alongside compressions.
When only one rescuer is present, the ratio is 30 compressions to 2 breaths (30:2), prioritizing continuous compressions for simplicity. The single rescuer must manage both compressions and ventilations, which leads to unavoidable pauses in chest compression delivery. With two rescuers, the 15:2 ratio is used because the second person administers breaths more quickly. This ensures the infant receives a higher overall number of ventilations per minute, better addressing the primary respiratory issue while the dedicated compressor maintains the required rate.