Cardiac arrest in children requires immediate intervention. Unlike most adult cases, a child’s heart often stops due to a lack of oxygen rather than a primary heart problem. Correct cardiopulmonary resuscitation (CPR) helps keep oxygenated blood circulating to the brain and other vital organs until medical help arrives. When two trained rescuers are present, a team approach is used, following standardized guidelines for a child (age one to the onset of puberty). The specific ratio of chest compressions to rescue breaths changes when a second rescuer is available.
The Standard Two-Rescuer Ratio for Children
The standard compression-to-ventilation ratio for two-rescuer CPR on a child is 15 compressions followed by 2 ventilations (15:2). This ratio is recommended when two individuals perform CPR collaboratively. The presence of a second rescuer allows one person to focus on delivering high-quality chest compressions while the other administers the rescue breaths. This division of labor helps to minimize the pauses in chest compressions, which improves survival outcomes.
By contrast, the ratio for a single rescuer performing child CPR remains 30 compressions to 2 ventilations (30:2), matching the adult single-rescuer protocol. The adjustment to 15:2 is a deliberate strategy to increase the frequency of breaths delivered without compromising the necessary blood flow generated by compressions. This change effectively doubles the number of breaths given per cycle compared to the single-rescuer ratio.
The Rationale for Increased Ventilation Frequency
The reason for the increased frequency of ventilations in two-rescuer child CPR is rooted in the common cause of pediatric cardiac arrest. Most cardiac arrests in children and infants begin with respiratory failure or shock, leading to severely depleted oxygen levels (hypoxia) before the heart stops beating. This differs significantly from adults, whose cardiac arrests are most often caused by a primary electrical problem in the heart. Therefore, the priority in pediatric resuscitation must be to rapidly correct the oxygen deficiency.
The 15:2 ratio ensures the child receives more frequent breaths. This higher ventilation frequency is crucial for re-oxygenating the blood and reversing the underlying respiratory issue that caused the cardiac arrest. The coordinated action of the two rescuers allows this emphasis on ventilation to occur with minimal interruptions to the blood-pumping action of the chest compressions.
Ensuring High-Quality CPR Technique
Beyond the correct ratio, the mechanical execution of CPR must adhere to strict standards. High-quality chest compressions must be delivered at a consistent rate of 100 to 120 compressions per minute. The force applied must be sufficient to depress the chest by approximately two inches, or about one-third the front-to-back depth of the child’s chest.
Proper hand placement involves using the heel of one or two hands on the lower half of the breastbone, avoiding pressure on the ribs or the very bottom of the sternum. Allowing the chest to fully recoil after each compression is equally important, permitting the heart to refill with blood. The rescuer delivering breaths must ensure that each ventilation causes a visible rise of the child’s chest, confirming air entry into the lungs. The two-rescuer team should aim to minimize the time spent pausing compressions for breaths, keeping interruptions to less than 10 seconds.