The onset of cardiac arrest in a child is a medical emergency demanding immediate and effective cardiopulmonary resuscitation (CPR). Unlike adults, cardiac arrest in children frequently stems from respiratory failure, making the prompt delivery of oxygenated breaths especially important. High-quality CPR, guided by specific medical guidelines from organizations like the American Heart Association (AHA), provides the best chance for survival. Knowing the precise ratio and technique for pediatric CPR is a necessary skill for any potential rescuer.
Defining the Child Patient and Recognizing Arrest
A “child” in CPR guidelines is defined as a person from one year of age up to the onset of puberty, based on physical development rather than a strict age cutoff. This grouping is used because a child’s body size and physiological needs require different techniques and force compared to an infant or an adult.
Cardiac arrest in children is most often secondary to a lack of oxygen, resulting from respiratory issues such as choking, severe asthma, drowning, or trauma. This differs significantly from adults, whose cardiac arrest is commonly caused by primary heart events. Recognizing arrest involves checking for unresponsiveness, observing for no normal breathing or only gasping, and quickly assessing for a pulse. If the child is unresponsive and not breathing normally, CPR should begin immediately.
The Two-Rescuer Ratio: Compressions and Ventilations
The required two-rescuer compression-to-ventilation ratio for a child is fifteen compressions followed by two ventilations (15:2). This ratio is designated for scenarios where two rescuers are available to perform CPR simultaneously. The goal of this coordinated effort is to minimize interruptions to chest compressions while ensuring the child receives adequate rescue breaths.
In this situation, one person focuses on delivering high-quality chest compressions, while the second manages the airway and provides the two rescue breaths. This division of labor optimizes the quality and consistency of both compressions and ventilations. The 15:2 ratio ensures a more frequent delivery of oxygen than the single-rescuer ratio, which is beneficial given the respiratory nature of most pediatric arrests. Rescuers should switch roles approximately every two minutes to prevent fatigue and maintain compression quality.
Technique and Quality for Pediatric CPR
Delivering high-quality pediatric CPR requires attention to technique. The required compression rate for a child is between 100 to 120 compressions per minute, a pace consistent across infants, children, and adults. This fast rhythm maintains blood flow to the brain and vital organs during the arrest.
The compression depth should be approximately two inches, or about one-third the front-to-back depth of the chest. Depending on the child’s size, compressions may be performed using the heel of one hand or two hands, focusing on achieving the correct depth without excessive force. Allowing the chest to fully recoil between each compression permits the heart to adequately refill with blood before the next pump. Minimizing the time paused between compression cycles maximizes blood circulation.
Why the Ratio Differs from Adult CPR
The 15:2 ratio for two-rescuer child CPR contrasts with the 30:2 ratio used for all adult CPR scenarios. This distinction is rooted in the different underlying causes of cardiac arrest between the two age groups. Since children most often suffer from hypoxia—a severe lack of oxygen—before their heart stops, they require more frequent ventilation early in the resuscitation process.
The higher proportion of breaths in the 15:2 ratio prioritizes oxygen delivery to combat initial respiratory failure. By providing a breath after every fifteen compressions, the child receives a greater overall volume of oxygen and ventilation per minute than they would with the adult ratio. This physiological difference underscores why specific, age-appropriate guidelines are followed to increase the chance of survival.