Infant cardiopulmonary resuscitation (CPR) is a time-sensitive intervention for babies (birth to one year) who have stopped breathing or whose heart has ceased beating. Most infant cardiac arrests are caused by respiratory failure rather than a primary heart issue. Therefore, providing both compressions to circulate blood and breaths to deliver oxygen is highly important in this age group. Precision in delivery, including the correct ratio of compressions to breaths, is necessary to maintain adequate oxygen and blood flow to the brain and other vital organs until professional medical help arrives.
Recognizing the Emergency and Initial Action Steps
Before beginning any life-saving measures, a rescuer must first ensure the scene is safe and check for responsiveness in the infant. For a baby, this check involves gently tapping the heel of the foot or the shoulder while shouting to see if there is any movement, crying, or reaction. The rescuer should then look, listen, and feel for normal breathing for no more than ten seconds. If the infant is unresponsive and not breathing normally, or is only gasping, the rescuer must activate the emergency medical system (EMS).
The immediate action of calling for help depends on whether the collapse was witnessed. If the rescuer is alone and the infant’s collapse was unwitnessed, the current protocol suggests performing two minutes of CPR (approximately five cycles) before stopping to call 911 or retrieve an automated external defibrillator (AED). Conversely, if the arrest was witnessed, the rescuer should immediately call 911 and retrieve the AED before starting CPR.
The 1-Rescuer CPR Ratio and Cycle (The 30:2 Rule)
For a single person performing CPR on an infant, the standardized compression-to-breath ratio is 30 compressions followed by 2 rescue breaths, commonly referred to as the 30:2 rule. This ratio is consistent for all age groups when only one rescuer is present, simplifying training and application. The goal of the compressions is to manually pump blood throughout the infant’s body, while the breaths replenish the oxygen supply.
The 30:2 cycle must be performed continuously, with minimal interruptions, to maintain a consistent flow of blood. A full cycle consists of the sequence of 30 compressions and 2 breaths, which the rescuer should repeat five times. This five-cycle period should take about two minutes to complete, after which the rescuer should briefly re-evaluate the infant’s condition or pause to call EMS if they had not done so already.
Proper Technique for Infant Compressions and Breaths
Effective chest compressions are delivered with the infant lying on a firm, flat surface. For a single rescuer, the recommended technique involves using two fingers, typically the index and middle fingers, placed on the center of the breastbone just below the nipple line. The compressions must be delivered at a rate between 100 and 120 compressions per minute, which is the same rate used for adults.
The depth of each compression is also specific, requiring the chest to be pushed down approximately 1.5 inches, or about one-third the total depth of the chest. It is equally important to allow the chest to fully recoil back to its normal position after each compression. Failing to allow complete recoil reduces the heart’s ability to refill with blood, which diminishes the effectiveness of the next compression.
When providing the rescue breaths, the rescuer must open the airway by gently tilting the head into a neutral or slightly sniffing position. The rescuer should form an airtight seal by placing their mouth over both the infant’s nose and mouth. The breaths should be delivered as small, gentle puffs of air, lasting about one second each. The rescuer should watch the chest to ensure it visibly rises with each breath, indicating successful air entry.