CPR for a child (approximately one year of age until puberty) follows guidelines distinct from those for adults. A child’s cardiac arrest often stems from respiratory failure, such as severe asthma or drowning, rather than a primary heart event. This emphasizes the need for rescue breaths. Understanding the specific protocols for this age group, including the correct compression-to-ventilation ratio, provides the best chance of survival.
Activating Emergency Services and Initial Assessment
A rescuer must quickly assess the situation before beginning chest compressions. First, establish responsiveness by gently tapping the child and shouting. If there is no response, the rescuer must look for breathing and feel for a pulse, a process that should take no longer than 10 seconds. In children, the pulse check is typically performed on the carotid artery in the neck or the femoral artery in the groin.
If the child is not breathing, is only gasping, or has no pulse, CPR should be started immediately. Compressions are also warranted if the pulse rate is below 60 beats per minute, especially with signs of poor circulation. If the rescuer is alone and the collapse was not witnessed, the protocol requires performing approximately two minutes of CPR (about five cycles) before pausing to call emergency services and retrieve an Automated External Defibrillator (AED). This two-minute period addresses the child’s likely respiratory problem first, though calling immediately is appropriate if the collapse was seen.
The Standard Ratio for a Single Rescuer
When a single rescuer performs CPR on a child, the compression-to-ventilation ratio is 30 compressions followed by 2 rescue breaths. This ratio simplifies training for lay rescuers and ensures that chest compressions, which circulate oxygenated blood, are prioritized with minimal interruptions. The lone rescuer completes 30 compressions, opens the airway, delivers 2 effective breaths, and immediately returns to compressions.
The continuous 30:2 cycle is repeated until a second rescuer arrives or emergency medical services take over. Although breaths are important due to the common respiratory cause of pediatric arrest, interruptions to compressions must be brief. If a rescuer cannot deliver rescue breaths, providing chest compressions alone is still recommended to maintain blood flow until professional help arrives.
Adapting the Ratio for Two Rescuers
The compression-to-ventilation ratio changes when a second trained rescuer assists with CPR. In a two-rescuer scenario, the ratio is adjusted to 15 compressions followed by 2 rescue breaths. This modification improves the quality and efficiency of the resuscitation effort.
With two rescuers, one focuses entirely on delivering high-quality compressions while the second manages the airway and ventilations. The 15:2 ratio allows for more frequent delivery of rescue breaths, which is beneficial since pediatric cardiac arrest is often secondary to lack of oxygen. Rescuers should coordinate their actions and switch roles approximately every two minutes to prevent fatigue and maintain compression quality.
Quality Mechanics of Compression and Ventilation
The physical technique for delivering compressions and breaths must meet specific standards to be effective. Chest compressions must be delivered at a consistent rate of 100 to 120 per minute. Compressions should be deep enough to displace the chest by about 2 inches, corresponding to approximately one-third of the child’s chest depth.
The rescuer should place the heel of one or two hands on the lower half of the child’s breastbone, depending on the child’s size. It is necessary to allow the chest to fully recoil after each compression, permitting the heart to refill with blood. For rescue breaths, the rescuer must use the head tilt-chin lift maneuver to open the airway. Each breath should be delivered over approximately one second, causing a visible, gentle rise of the chest, while avoiding excessive ventilation.