Cardiopulmonary Resuscitation (CPR) combines chest compressions and rescue breaths to maintain blood flow and oxygen delivery when a person’s heart or breathing has stopped. This life-saving technique is modified for different age groups. An infant is generally defined as a baby under one year of age. Since cardiac arrest in infants often results from breathing failure, a quick response including both circulation and ventilation is necessary.
Recognizing the Need and Calling for Help
The first step is a rapid assessment to determine if an infant requires intervention. A rescuer should gently tap the baby’s foot or shoulder and call out to check for responsiveness, avoiding shaking the infant. If the infant is unresponsive and not breathing normally (only gasping or not breathing at all), immediate action is required.
The next step involves activating emergency medical services (EMS) by calling 911 or a local emergency number. If a rescuer is alone, the timing depends on the situation, known as “Call Fast vs. Care Fast.” If the infant’s collapse was witnessed and likely heart-related, the rescuer should call EMS immediately.
If the collapse was unwitnessed or likely related to a breathing problem, a lone rescuer should perform two minutes of CPR (approximately five cycles) before pausing to call for help. This prioritizes oxygen delivery, as cardiac arrest in infants is often secondary to respiratory distress. After calling, the rescuer must return and continue CPR until emergency personnel arrive or the infant starts breathing.
The Standard Compression-to-Breath Sequence
The ratio of compressions to breaths varies depending on the number of rescuers present. When a single rescuer performs CPR, the standard ratio is 30 chest compressions followed by 2 rescue breaths (30:2). This sequence maximizes the circulation of oxygenated blood while providing a manageable rhythm for one person.
When two rescuers are present, the sequence changes to 15 compressions followed by 2 rescue breaths (15:2). This 15:2 ratio allows for more frequent ventilations, which is beneficial since infants often experience cardiac arrest due to lack of oxygen. Compressions for both ratios should be delivered at a rate of 100 to 120 per minute.
The two-rescuer ratio allows for consistent oxygen delivery, addressing the underlying cause of arrest, which is frequently respiratory failure. The goal is to perform five cycles of the appropriate ratio within a two-minute timeframe. Interruptions in chest compressions should be minimized to no more than 10 seconds to maintain continuous blood flow.
Executing Infant CPR Techniques
The physical technique for infant CPR is adapted to the baby’s small size. For a lone rescuer performing the 30:2 sequence, the two-finger technique is typically used. The rescuer places the index and middle fingers on the center of the breastbone, just below the imaginary nipple line.
The chest should be compressed to a depth of approximately 1.5 inches, or about one-third the total depth of the chest. Allow the chest to fully recoil after each compression, which permits the heart to refill with blood. If a second rescuer is present, the two-thumb-encircling-hands technique is preferred for potentially more consistent depth and pressure.
For rescue breaths, the rescuer must open the infant’s airway using the head-tilt/chin-lift maneuver, tilting the head only slightly to avoid closing the airway. The rescuer places their mouth over both the infant’s mouth and nose to form a complete seal. Breaths should be gentle “puffs” of air, delivered over about one second, with volume sufficient only to cause the chest to visibly rise.