Infant cardiopulmonary resuscitation (CPR) is a life-saving sequence of actions performed on a baby under one year of age who is unresponsive and not breathing normally. Cardiac arrest in infants is typically a result of respiratory failure or shock, meaning the immediate delivery of oxygen and blood circulation is important. Following current standard guidelines significantly increases the chance of survival during an emergency. Infant CPR is different from adult CPR, and understanding these nuances is necessary for effective intervention.
Activating Emergency Services
The immediate priority for any rescuer is to ensure the scene is safe. Once safety is confirmed, the rescuer should determine the infant’s responsiveness by gently tapping the bottom of the foot. If the infant is unresponsive and not breathing, or only gasping, the rescuer must immediately shout for nearby help to assist with calling emergency services.
The sequence of when to call for help depends on whether the rescuer is alone and if the collapse was witnessed. If the rescuer is alone and did not witness the collapse, they should administer two minutes of CPR before calling emergency services. If the collapse was witnessed, or if a second rescuer is present, the emergency number should be called immediately while CPR begins.
If a second rescuer is available, they should be directed to call emergency services and locate an Automated External Defibrillator (AED) while the first rescuer starts chest compressions. Minimizing the time between the infant’s collapse and the start of high-quality CPR is a major factor in survival.
Understanding Compression-to-Ventilation Ratios
The compression-to-ventilation ratio depends on the number of trained rescuers present. The 15 compressions to 2 ventilations (15:2) ratio is the standard when two or more trained rescuers are working together. One rescuer delivers chest compressions, while the second manages the airway and delivers rescue breaths.
In contrast, the standard for a single rescuer performing infant CPR is a ratio of 30 compressions followed by 2 breaths (30:2). This protocol applies to both lay rescuers and healthcare providers working alone. The purpose of the 30:2 ratio is to maximize the number of compressions delivered before the rescuer must pause for breaths.
The 15:2 ratio is used with two rescuers because it allows for a higher number of ventilations over time, which is beneficial since respiratory issues frequently cause cardiac arrest in infants. Splitting the duties helps minimize fatigue and reduces the pause between compressions and breaths. The adjustment from 30:2 to 15:2 optimizes the balance between circulating oxygenated blood and delivering oxygen to the lungs.
Technique for Chest Compressions
For effective infant CPR, chest compressions must be delivered on a firm, flat surface. The correct location is on the lower half of the breastbone, just below an imaginary line drawn between the infant’s nipples. Rescuers must avoid pressing on the xiphoid process (the bottom tip of the breastbone) to prevent internal injury.
The depth of each compression should be approximately 1.5 inches, which is about one-third the total depth of the infant’s chest. This depth is necessary to adequately squeeze the heart between the breastbone and the spine to circulate blood. Compressions should be delivered at a rapid rate, between 100 and 120 compressions per minute.
A lone rescuer typically uses the two-finger technique. When two rescuers are present, the two-thumb encircling hands technique is often preferred, as it may provide more consistent compression depth and pressure. With every compression, allow the chest to fully recoil back to its normal position before the next compression, ensuring the heart can refill with blood.
Administering Rescue Breaths
After the required number of compressions, the rescuer must quickly transition to opening the airway to administer rescue breaths. The infant’s head should be positioned in a neutral or slightly “sniffing” position, achieved with a gentle head-tilt and chin-lift. Avoid over-extending the neck, as this can inadvertently close the airway.
To deliver the breath, the rescuer must form a tight seal by placing their mouth completely over both the infant’s nose and mouth. The breath should be delivered slowly and gently over approximately one second, providing only enough air to make the chest visibly rise. Observing the chest rise confirms the breath has entered the lungs.
Allow the air to escape and the chest to fall before delivering the second breath. Avoid blowing too forcefully, as excessive pressure can lead to air entering the stomach, which can cause complications like vomiting. The entire sequence of two breaths should be completed quickly to minimize the interruption of chest compressions and maintain blood flow.