Cardiopulmonary Resuscitation (CPR) for an infant is a time-sensitive intervention necessary when breathing or the heart has stopped. The infant heart often stops due to a lack of oxygen, resulting from a respiratory problem rather than a primary cardiac issue. Rapid and correct action by a single rescuer is paramount, as oxygen deprivation can quickly lead to irreversible damage. This procedure requires a specialized approach that differs from adult CPR, focusing on effective compressions and rescue breaths to circulate oxygenated blood until professional help arrives.
Initial Steps and Emergency Activation
The first action taken by any rescuer must be to ensure the scene is safe. Once the environment is secure, the rescuer should check for responsiveness by gently tapping the infant’s foot. If the infant does not respond, immediately shout for help from anyone nearby.
A lone rescuer must then quickly check for breathing or gasping and simultaneously check for a pulse, which is most reliably felt in the brachial artery. This check should take no more than 10 seconds. If the infant is not breathing or is only gasping, and no pulse is felt, or the heart rate is less than 60 beats per minute with signs of poor circulation, chest compressions must begin immediately. The sequence for activating the Emergency Response System (ERS/911) depends on whether the collapse was witnessed.
If the infant’s collapse was witnessed, the rescuer should immediately call 911 and retrieve an Automated External Defibrillator (AED) if one is available. However, if the collapse was unwitnessed, the lone rescuer should perform two minutes of CPR first before pausing to call for help and retrieve an AED. This “care first” approach prioritizes delivering immediate oxygen and circulation, as the most likely cause is a respiratory failure. The infant must be placed on a firm, flat surface to ensure compressions are effective.
Technique for Chest Compressions
The mechanical action of chest compressions is adapted for the infant. The single rescuer uses the two-finger technique, employing the tips of the index and middle fingers to deliver compressions. These fingers are placed vertically on the lower half of the sternum, directly in the center of the chest, taking care to avoid the end of the breastbone, known as the xiphoid process.
Delivering compressions requires sufficient force to depress the chest by approximately 1.5 inches, or about one-third of the infant’s chest depth. This depth is necessary to adequately squeeze the heart between the sternum and the spine, generating blood flow to the brain and other organs. The rate of compression must be delivered at a speed of 100 to 120 compressions per minute.
After each compression, allow the chest wall to fully recoil back to its normal position without leaning on the chest. This complete release permits the heart to refill with blood before the next compression is delivered. Maintaining this consistent depth and rate, with full recoil, is a defining factor in providing high-quality CPR. The rescuer should aim to minimize any interruptions to the compressions, keeping the hands-off time as brief as possible.
Coordinating Compressions and Rescue Breaths
For a single rescuer, the compressions must be periodically interrupted to deliver rescue breaths, forming a continuous cycle of 30 compressions followed by 2 ventilations. This 30:2 compression-to-ventilation ratio is the standard protocol for one-rescuer infant CPR. After the 30th compression, the rescuer must quickly open the infant’s airway using a gentle head-tilt-chin-lift maneuver.
The airway is opened only slightly past the neutral position, as hyperextending an infant’s neck can actually close the airway. The rescuer then uses their mouth to create a seal over both the infant’s mouth and nose simultaneously. Two rescue breaths are delivered, each lasting about one second, with only enough volume to make the infant’s chest visibly rise and fall.
If the first breath does not cause the chest to rise, the rescuer must quickly reposition the head and attempt the second breath, ensuring the airway is properly open before immediately returning to the next cycle of 30 compressions. The goal is to perform approximately five cycles of 30 compressions and 2 breaths within the two minutes before pausing, if necessary, to call for help. CPR should be continued until emergency medical services arrive, the infant shows signs of recovery, or the rescuer becomes too exhausted to continue.