Cardiopulmonary Resuscitation (CPR) is an emergency life-saving procedure that sustains blood flow to the brain and heart when a person’s heart stops beating. It combines chest compressions and rescue breathing to manually circulate oxygenated blood until advanced medical help arrives. While the fundamental goal remains the same, the human body’s underlying physiology changes significantly from infancy through adulthood. These biological differences necessitate distinct protocols to ensure the resuscitation efforts are both effective and safe. Understanding these age-specific modifications is necessary for anyone providing aid, and the following sections outline the specific variations in technique and sequence.
How Age Defines the CPR Protocol
The application of CPR is governed by precise age-based classifications established by resuscitation guidelines, as the mechanical and physiological requirements shift across the lifespan. An individual is categorized as an “Infant” from birth up to one year of age. The “Child” category covers those from one year of age up to the onset of puberty, which is often approximated by the presence of secondary sexual characteristics. Finally, anyone who has reached puberty or is older is classified as an “Adult” for the purposes of CPR, and the standard adult protocol is applied. Using the correct category is a foundational step because applying the force or ratio intended for an adult to a small child can cause significant harm.
The Critical Initial Response Sequence
A primary divergence between adult and pediatric CPR occurs in the sequence of actions taken immediately following the recognition of an unresponsive person. For adults, the cause of collapse is most frequently a sudden cardiac event, such as ventricular fibrillation, which requires an immediate defibrillator shock. Therefore, the standard protocol for an adult mandates a “Call First” approach, where the rescuer immediately calls emergency services and retrieves an Automated External Defibrillator (AED) before initiating CPR. This prioritizes rapid access to the definitive treatment.
The situation is different for children and infants, whose cardiac arrests are typically secondary to an underlying respiratory problem, such as choking or trauma leading to oxygen deprivation. This asphyxial cause means that immediate delivery of rescue breaths and chest compressions is paramount to re-oxygenate the blood. For an unwitnessed collapse of a child or infant, the “Care First” approach is followed. The rescuer should perform two minutes of CPR—approximately five cycles of compressions and breaths—before calling emergency services. This initial period of high-quality CPR provides the most immediate life-sustaining intervention.
Variations in Chest Compression Technique
The physical technique for delivering chest compressions must be adapted to the patient’s body size and bone structure to ensure efficacy without causing internal injury. The compression rate remains consistently high across all age groups, aiming for 100 to 120 compressions per minute to maximize blood flow. The required depth of compression changes significantly to reflect the differing chest sizes.
For an adult, the chest must be compressed to a depth of at least two inches, or roughly five to six centimeters, to effectively squeeze the heart between the sternum and the spine. This depth requires the rescuer to use two hands, one stacked on top of the other, with the heel of the hand positioned on the center of the chest.
In contrast, a child requires a compression depth of about two inches, or approximately one-third of the total chest depth, whichever is less. A rescuer may use either one or two hands for a child, adjusting based on the child’s size to achieve the appropriate depth.
Infants require the most specialized compression technique due to their small, delicate stature. The compression depth is reduced to about one-and-a-half inches, which is approximately one-third of the infant’s chest depth. A single rescuer typically uses only two fingers, placed just below the nipple line. If two rescuers are present, the preferred method is the two-thumb encircling technique, where both hands wrap around the infant’s torso and the thumbs are used to compress the chest.
Differences in Ventilation Ratios and Delivery
Ventilation, or rescue breathing, is a more prominent component of pediatric CPR due to the respiratory nature of most pediatric cardiac arrests, which influences the required compression-to-ventilation ratio. For a single rescuer performing CPR on any age group—adult, child, or infant—the ratio is uniformly 30 chest compressions followed by two rescue breaths. This standardized approach simplifies training for lay rescuers and ensures compressions are prioritized.
The ratio changes significantly for pediatric patients when two trained rescuers are present, shifting to 15 compressions followed by two breaths. This adjustment to a 15:2 ratio for children and infants recognizes that their primary need is oxygen, thus allowing for a greater frequency of rescue breaths to be delivered per minute.
The method of delivering the breath also varies based on size; while adults receive mouth-to-mouth breaths, an infant’s small facial features often necessitate the rescuer covering both the nose and mouth simultaneously with their own mouth to create a proper seal. In all cases, the volume of air delivered should only be enough to cause a visible, gentle rise of the chest, avoiding forceful breaths that could potentially injure the patient’s lungs.