High-quality cardiopulmonary resuscitation (CPR) is a time-sensitive intervention that significantly improves the outcome for an infant experiencing a cardiac or respiratory emergency. Infant CPR is specifically designed for a child under one year of age, whose smaller, more delicate anatomy requires a modified approach compared to adults. Chest compressions are the primary mechanism to manually circulate oxygenated blood to the brain and other vital organs, sustaining life until advanced medical support arrives. Understanding the correct technique, particularly the appropriate number of fingers to use, is paramount to delivering effective and safe compressions.
Recognizing the Need for Intervention
Before initiating chest compressions, a lay rescuer must first ensure the scene is safe. The rescuer should check for responsiveness by gently tapping the infant’s heel or shoulder. If the infant remains unresponsive, the rescuer must immediately shout for help to activate the emergency medical services (EMS) system. This prompt activation allows professional help to be dispatched quickly.
The rescuer then quickly checks for normal breathing or signs of life for no more than ten seconds. Effective chest compressions are necessary if the infant is not breathing or is only gasping, which is a sign of abnormal breathing. If the rescuer is alone, they should begin CPR immediately and perform two minutes of compressions and breaths before calling emergency services if a phone is not readily available. Lay rescuers should not attempt to check for a pulse, as this can lead to delays in starting compressions.
The Two-Finger Compression Technique
For a single lay rescuer, the most common method for chest compressions involves using only two fingers. This technique allows the rescuer to maintain the infant’s airway with the other hand while simultaneously providing compressions and rescue breaths. The correct position involves placing the tips of the index and middle fingers, or the middle and ring fingers, on the breastbone just below the nipple line. It is important to avoid pressing on the xiphoid process, the small cartilage at the bottom of the breastbone, to prevent potential injury.
The compressions should be delivered using the strength from the hand and wrist, keeping the fingers straight and avoiding bending them at the knuckles. This helps to ensure the force is directed straight down onto the sternum. The two-finger method minimizes the risk of causing trauma to the infant’s delicate rib cage or abdomen. If the rescuer finds they cannot achieve the required compression depth with two fingers, they may use the heel of one hand as an alternative to ensure effective circulation is maintained.
Essential Parameters for Effective Compressions
The effectiveness of infant CPR depends on correct hand placement and maintaining specific technical parameters for rate and depth. Compressions must be delivered at a consistent rate of 100 to 120 compressions per minute. The depth of each compression is important, requiring the rescuer to push down approximately 1.5 inches, or about one-third the total depth of the infant’s chest.
Between each compression, allow the chest to fully recoil back to its normal position. Full chest recoil allows the heart to refill with blood, which is necessary for the next compression to be effective in circulating blood. For the single rescuer, the compression-to-ventilation ratio is 30 compressions followed by 2 rescue breaths, prioritizing circulation while providing adequate oxygenation. When two trained rescuers are present, the ratio shifts to 15 compressions for every 2 breaths, which allows for more frequent ventilation.
The Two-Thumb Encircling Method
The two-thumb encircling method is the preferred compression technique when two trained rescuers are available. This technique involves the rescuer wrapping both hands around the infant’s torso, with the fingers supporting the infant’s back. Both thumbs are then placed side-by-side on the breastbone, just below the nipple line. The thumbs are used to deliver the compressions at the required rate and depth.
The encircling hands provide better support for the infant’s back, helping to stabilize the body during the compressions. Studies indicate that this method generates more consistent compression depth compared to the two-finger technique. This method is favored by professional rescuers because it is less fatiguing over time and produces superior artificial circulation. Since this technique requires both hands for compressions, a second rescuer must focus on delivering the rescue breaths and managing the airway, using the 15:2 ratio.