Cardiac arrest in children is overwhelmingly caused by a lack of oxygen, known as asphyxial arrest. This fundamental difference means that providing effective ventilations is a high priority during pediatric resuscitation efforts. Unlike cardiac arrest in adults, which is often caused by a sudden heart rhythm problem, the procedures are highly specific and diverge significantly from those used for an adult. Knowing the correct technique and the specific number of breaths to deliver is crucial for a successful recovery.
Defining the “Child” in Emergency Care
Emergency protocols establish a clear age-based definition for a “child” to ensure the correct resuscitation techniques are applied. For CPR guidelines, a child is defined as an individual from approximately one year of age up to the onset of puberty. Puberty is typically recognized by the presence of breast development in females or axillary (underarm) hair in males. This classification is necessary because the mechanical and physiological needs of this age group differ from both infants and adults. An infant is defined as a person under one year of age, requiring a different set of techniques. Individuals who have reached puberty are treated using adult resuscitation guidelines.
Ventilation Frequency for Rescue Breathing (Pulse Present)
When a child is not breathing or is only gasping but a pulse is still detected, this is known as respiratory arrest. This situation is frequently a precursor to full cardiac arrest, meaning intervention is time-sensitive. The rescuer should focus exclusively on rescue breathing to rapidly restore oxygen levels. Compressions are not necessary since the heart is still circulating blood.
The recommended frequency is one breath approximately every two to three seconds, translating to a ventilation rate of 20 to 30 breaths per minute. Breaths must be delivered gently but effectively, ensuring the child’s chest visibly rises. Excessive or overly forceful ventilations should be avoided, as they can lead to air entering the stomach and causing complications.
The rescuer must continue this pattern while periodically checking the child for changes. The pulse should be re-assessed roughly every two minutes. If the pulse rate remains below 60 beats per minute with signs of poor circulation, or if the pulse disappears, the rescuer must immediately transition to full CPR, including chest compressions.
Integrating Ventilations During Full CPR
When a child is unresponsive, not breathing, and has no detectable pulse, full CPR is required, combining compressions and ventilations. The number of ventilations delivered is tied directly to the number of chest compressions in a defined ratio. The appropriate compression-to-ventilation ratio is determined by the number of rescuers present.
If a single rescuer is performing CPR, the recommended ratio is 30 compressions followed by 2 ventilations (30:2). This ratio aligns with the standard adult CPR protocol, which simplifies training for lay rescuers. Compressions must be delivered at a rapid rate of 100 to 120 per minute, with the two ventilations delivered quickly after the 30th compression before immediately resuming compressions.
When two or more rescuers are present, the ratio changes significantly to 15 compressions followed by 2 ventilations (15:2). This specific pediatric protocol provides a higher proportion of ventilations, better addressing the oxygen depletion common in these cases.
In a two-rescuer scenario, one rescuer delivers compressions while the second manages the airway and provides ventilations. Roles should be switched every two minutes (or after five cycles of 15:2) to prevent fatigue and maintain compression quality. Minimizing interruption time is paramount to maintaining blood flow to vital organs.
Essential Technique for Effective Ventilations
The mechanical execution of delivering a rescue breath is just as important as knowing the correct frequency or ratio. Before delivering any breath, the rescuer must ensure the child’s airway is open using the head-tilt, chin-lift maneuver. This involves gently tilting the head back and lifting the chin forward to move the tongue away from the throat, creating a clear pathway for air.
Once the airway is open, the rescuer must create a proper seal over the child’s mouth while pinching the nose shut. A barrier device, such as a pocket mask, is preferred to ensure a tight seal and reduce the risk of cross-contamination. If unavailable, use a mouth-to-mouth technique, ensuring no air escapes.
Each ventilation should be delivered slowly and controlled over about one second. Use only enough air to make the child’s chest visibly rise, similar to a normal breath. Watching for this chest rise confirms the breath successfully entered the lungs. If the chest does not rise, quickly reposition the head using the head-tilt, chin-lift maneuver and attempt the second breath before immediately resuming compressions.