Cardiopulmonary Resuscitation (CPR) is an intervention used to manually circulate blood and oxygen when an infant’s heart has stopped or is beating ineffectively. When performed on an infant, the technique focuses on generating enough pressure to move oxygen-rich blood to the brain and other organs. Because cardiac arrest in infants is most often caused by a respiratory issue, chest compressions must be paired with rescue breaths to supply oxygen. Understanding the correct physical technique and specific measurements is necessary for providing effective support during a medical emergency.
Recognizing the Need for CPR
Before beginning CPR, a rescuer must first ensure the scene is safe and quickly determine the infant’s condition. The initial step involves assessing responsiveness by gently tapping the infant’s heel and shouting to elicit a reaction. If the infant does not respond, they are considered unresponsive.
The rescuer must simultaneously check for breathing and a pulse, a process that should take no more than ten seconds. The pulse is typically checked at the brachial artery, located on the inside of the infant’s upper arm between the elbow and shoulder. If the infant is not breathing normally, or is only gasping, and has no pulse or a pulse rate below 60 beats per minute, compressions must be started immediately.
If a single rescuer is present without a mobile phone, they must perform CPR for two minutes before leaving the infant to call emergency medical services (EMS) or retrieve an automated external defibrillator (AED). If the rescuer has a phone, they should activate the emergency response system immediately using speakerphone to begin CPR without delay. If a second person is available, one person can immediately call EMS while the other begins the resuscitation sequence.
Achieving the Correct Compression Depth
Achieving the necessary compression depth is crucial for effective infant CPR, ensuring blood circulation. The required depth is approximately 1.5 inches (four centimeters), which corresponds to about one-third of the total front-to-back depth of the infant’s chest. Applying pressure that is too shallow will not effectively pump blood, while compressing too deeply risks causing internal injury.
For a single rescuer, the most common method is the two-finger technique. The rescuer places the tips of two fingers, usually the index and middle fingers, on the breastbone just below the imaginary line connecting the infant’s nipples. The pressure must be applied straight down using the weight of the rescuer’s upper body, rather than just the strength of the fingers.
When two rescuers are present, the two-thumb encircling technique is the preferred method, as it delivers a more consistent and deeper compression. In this technique, the rescuer performing compressions wraps both hands around the infant’s torso, placing both thumbs side-by-side on the breastbone. The hands support the infant’s back, and the compressions are delivered using the thumbs.
Regardless of the technique used, the chest must be allowed to fully recoil between each compression. Full recoil means allowing the sternum to return completely to its normal position, which allows the heart to refill with blood before the next compression. Leaning on the chest between compressions prevents this refilling process, significantly reducing the effectiveness of the intervention.
Integrating Rate and Rescue Breaths
Delivering compressions at the correct rate ensures a continuous flow of blood to the brain and heart. Current guidelines recommend a compression rate of 100 to 120 compressions per minute for infants. Rescuers should aim for a quick, steady rhythm, often described as matching the tempo of a fast-paced song.
Compressions must be combined with rescue breaths in a specific ratio to replenish the oxygen supply. For a single rescuer, the standard ratio is 30 compressions followed by 2 breaths (30:2). This cycle is repeated continuously until EMS arrives or the infant shows definitive signs of life.
If two rescuers are present, they switch to a ratio of 15 compressions followed by 2 breaths (15:2). This lower ratio allows for more frequent ventilation without significant interruption to chest compressions. Rescuers should switch roles approximately every two minutes to prevent fatigue, which can quickly compromise the quality of compressions and depth.
Rescue breaths involve covering both the infant’s nose and mouth with the rescuer’s mouth to create an airtight seal. A gentle puff of air should be delivered over about one second. The goal is to see a visible rise in the infant’s chest, indicating air has entered the lungs, followed by allowing the chest to fall before delivering the second breath. Excessive force or volume should be avoided, as an infant’s lungs require only a small amount of air.