Cardiopulmonary resuscitation (CPR) is a life-saving technique performed when a child’s breathing or heartbeat has stopped, often due to drowning, choking, or injury. This immediate intervention is crucial, as permanent brain damage or death can occur rapidly if blood flow ceases. “High-quality CPR” is a comprehensive approach that maximizes survival and improves outcomes by ensuring each component of the resuscitation effort is performed effectively.
Recognizing the Emergency and Activating Help
Before initiating CPR, quickly assess the situation and call for assistance. Begin by checking the child for responsiveness; gently tap or shake them and ask loudly, “Are you okay?”. If there is no response, immediately shout for help to attract attention from others nearby.
If the child is unresponsive, send someone to call emergency medical services (EMS), such as 911 in the US, and retrieve an automated external defibrillator (AED) if available. If you are alone and did not witness the collapse, begin CPR for approximately two minutes before making the call yourself. Conversely, if you witnessed the collapse while alone, call EMS first, then retrieve an AED if accessible, and promptly begin CPR.
An AED is a portable device that can analyze heart rhythms and deliver an electrical shock to restore a normal heartbeat. AEDs are generally safe for children, including infants, and are often found in public places. If pediatric pads are available, use them for children under 8 years; if not, adult pads can be used by placing one on the child’s chest and one on their back to prevent them from touching.
High-Quality Chest Compressions
Effective chest compressions are fundamental to high-quality CPR, circulating oxygenated blood to vital organs. The recommended rate for chest compressions in children is between 100 and 120 compressions per minute. This speed helps maintain consistent blood flow during resuscitation efforts.
Compression depth is equally important, aiming for approximately one-third the depth of the child’s chest. For infants (under one year), this typically means a depth of about 1.5 inches (4 cm). For children (ages one year to puberty), the depth should be around 2 inches (5 cm). It is important to push hard and fast to achieve the necessary depth and rate.
Allowing the chest to fully recoil after each compression is crucial for the heart to refill with blood before the next compression. Leaning on the chest between compressions can impede this refilling process, reducing the effectiveness of each compression. Proper recoil ensures maximum blood flow.
Correct hand placement varies depending on the child’s age. For infants, two fingers or two thumbs are typically placed just below the nipple line on the breastbone. For children, the heel of one or two hands is placed on the lower half of the breastbone, just below the nipple line. This precise placement ensures compressions are delivered to the heart, minimizing injury.
Minimizing interruptions to chest compressions is also a critical aspect of high-quality CPR. Pauses reduce blood flow to the brain and other organs, decreasing the overall effectiveness of resuscitation. Continuous compressions are prioritized to maintain consistent circulation.
Delivering Effective Rescue Breaths
Delivering effective rescue breaths complements chest compressions by providing oxygen to the child’s lungs. The first step involves opening the airway, typically by performing the head tilt-chin lift maneuver. For infants, the head should be in a neutral or slightly sniffing position, while for children, the head is tilted slightly past neutral. If a spinal injury is suspected, a jaw thrust maneuver can be used to open the airway without moving the neck.
Breathing technique varies slightly between age groups. For infants, the rescuer’s mouth covers both the infant’s mouth and nose to create a seal. For children, the rescuer’s mouth forms a seal over the child’s mouth, while the nose is pinched closed. Each breath should be delivered steadily over about one second, providing just enough air to make the chest visibly rise. Observing the chest rise indicates effective ventilation, and avoiding excessive ventilation is important.
After delivering a breath, allow the chest to fall as air exits before giving the next breath. If the chest does not rise with the first breath, re-tilt the head and ensure a proper seal before attempting a second breath. If the chest still does not rise, an object may be blocking the airway.
The recommended compression-to-breath ratios depend on the number of rescuers present. For a single rescuer, the ratio is 30 compressions to 2 breaths for both infants and children. When two rescuers are available, the ratio changes to 15 compressions to 2 breaths for both infants and children. These ratios ensure a balance between maintaining blood circulation and providing adequate oxygenation.
Ensuring Continuous CPR and Knowing When to Stop
Maintaining continuous chest compressions with minimal interruptions is paramount for effective CPR. Brief pauses, such as those for rescue breaths or AED analysis, should be kept as short as possible to sustain consistent blood flow to the brain and other vital organs. The goal is to maximize the time spent actively compressing the chest.
Rescuer fatigue can diminish the quality of compressions over time. To counteract this, rescuers should switch roles approximately every two minutes, or after five cycles of 30 compressions and 2 breaths, to ensure high-quality compressions are maintained. This rotation helps prevent exhaustion and preserves the effectiveness of the resuscitation effort.
CPR efforts should continue until one of several circumstances occurs. This includes when the child shows signs of life, such as breathing normally or moving. CPR can also be discontinued when trained emergency medical professionals arrive and take over care. Finally, if the rescuer becomes too exhausted to continue, it is an acceptable reason to stop CPR.