Cardiopulmonary Resuscitation (CPR) is a life-saving sequence of actions used when a person’s heart or breathing has stopped. The core purpose of CPR is to manually circulate oxygenated blood to the brain and other vital organs until professional medical help can take over. While the goal of CPR remains the same across all age groups, the specific techniques are significantly modified based on the patient’s size and underlying physiology. These adjustments ensure the intervention is both effective and safe.
The Primary Cause of Collapse
The most significant physiological difference determining CPR technique is the typical cause of collapse in each age group. For adults, cardiac arrest is most often a primary electrical or coronary event, meaning the heart stops first due to a sudden cardiac rhythm problem or a heart attack. This type of arrest requires immediate chest compressions to restart blood flow.
In contrast, cardiac arrest in infants and children is rarely a primary heart issue. It is most frequently a secondary result of respiratory failure or shock. Conditions like severe asthma, choking, drowning, or trauma often lead to a lack of oxygen, which subsequently causes the heart to stop. This difference dictates that pediatric CPR must prioritize fixing the underlying oxygen delivery problem, making rescue breaths a more prominent component of the initial resuscitation effort.
Sequence of Emergency Action
The assumed cause of collapse directly impacts the initial sequence of emergency actions for a lone rescuer. For an unwitnessed adult collapse, the recommended protocol is “Call First,” immediately contacting the emergency response system (EMS) before beginning chest compressions. This prioritizes the rapid arrival of a defibrillator, which is the definitive treatment for the electrical problems commonly causing adult cardiac arrest.
For an unwitnessed collapse of a child or infant, the lone rescuer should follow a “Care First” approach. This involves performing approximately two minutes of CPR, equating to five cycles of compressions and breaths, before pausing to call EMS. This delay allows the rescuer to provide the initial oxygen and ventilation needed to reverse the respiratory failure that is the likely cause of the pediatric arrest. If the collapse of any victim is witnessed, the rescuer should immediately call EMS, regardless of the patient’s age.
Differences in Chest Compression Technique
The mechanical execution of chest compressions is adjusted significantly to account for the smaller, more flexible anatomy of pediatric patients. For an adult, the rescuer uses the heel of two hands, one on top of the other, to compress the chest a minimum depth of two inches (about five centimeters).
In children, the rescuer may use one or two hands, depending on the child’s size, aiming for a depth of about two inches, or approximately one-third the depth of the chest. For infants (under one year), the technique is modified to use only two fingers or two thumbs encircling the chest, pressing down to a shallower depth of about one and a half inches (four centimeters). Across all age groups—adult, child, and infant—the compression rate remains the same, delivered at 100 to 120 compressions per minute.
Distinct Ventilation Procedures and Ratios
Ventilation procedures are specifically tailored to the patient’s size and oxygen needs. For an adult, rescue breaths are delivered mouth-to-mouth, ensuring each breath makes the chest visibly rise. For an infant, the rescuer must cover both the mouth and nose, administering a gentler puff of air to avoid over-inflating the smaller lungs.
The compression-to-ventilation (C:V) ratio also changes based on the number of rescuers present, reflecting the importance of oxygenation in pediatric cases. For a single rescuer performing CPR on any age group, the ratio is 30 compressions to 2 breaths (30:2). When two or more trained rescuers are present for a child or infant, the ratio shifts to 15 compressions to 2 breaths (15:2). This adjustment provides double the number of rescue breaths per cycle, directly addressing the respiratory cause of arrest more aggressively than the adult protocol.