When an infant stops breathing normally but still has a detectable pulse, it is an immediate, life-threatening medical emergency. This scenario, known as respiratory arrest with circulation, means the heart is still pumping oxygen-depleted blood. The lack of ventilation will quickly lead to cardiac arrest if not corrected. Initial care must support the infant’s breathing until professional medical help arrives.
Identifying Respiratory Arrest with Circulation
Recognizing respiratory arrest with a pulse requires a quick, two-part assessment: checking for breathing and checking for a pulse. Respiratory arrest is distinct from respiratory distress, where the infant is struggling but still moving air. In respiratory arrest, there is no normal breathing, only gasping or a complete absence of chest movement, signaling ventilatory failure.
To confirm a pulse in an infant, check the brachial artery, located on the inside of the upper arm between the elbow and the shoulder. Use two or three fingers and press gently for no more than ten seconds to feel for the rhythmic beat. Pushing too hard can occlude the small artery, making the pulse impossible to detect.
A definitely present pulse indicates the heart is still functioning, making ventilation the immediate priority. If a pulse is not felt, or if the rescuer is unsure within the ten-second window, the situation must be treated as cardiac arrest, requiring immediate cardiopulmonary resuscitation (CPR). The presence of a pulse confirms the need to focus entirely on restoring effective breathing.
Activating Emergency Services and Airway Management
The first step in any pediatric emergency is to activate the emergency response system, such as calling 911, or instructing a bystander to do so immediately. Getting professional help en route quickly is paramount, as initial emergency care is only a temporary measure. The second immediate step is positioning the infant to ensure a clear path for air delivery.
The infant should be placed on a firm, flat surface, such as the floor or a table, for effective rescue breathing. To open the airway, the infant must be placed into the “sniffing position.” This involves slightly extending the head to align the ear with the shoulder.
A towel or small blanket roll may need to be placed under the shoulders to counteract the natural neck flexion caused by the infant’s large head. This slight extension, known as the head-tilt/chin-lift maneuver, lifts the tongue away from the back of the throat. If a neck or spine injury is suspected, perform a jaw-thrust maneuver instead to open the airway without tilting the head. The infant must never be shaken, as this can cause catastrophic brain injury.
Step-by-Step Infant Rescue Breathing
Once the airway is open, immediately begin providing rescue breaths to deliver oxygen to the infant’s lungs. Due to the infant’s small size, the rescuer must cover both the infant’s mouth and nose with their own mouth to create an effective seal. The initial intervention involves delivering five “opening” or “clearing” breaths, which are slightly larger than the maintenance breaths that follow.
Each breath should be a gentle puff of air, lasting about one second, just enough to make the infant’s chest visibly rise. Avoid forceful or excessive ventilation, as this can cause air to enter the stomach, leading to gastric distension. After the first breath, watch the chest for a visible rise. If the chest does not rise, immediately reposition the airway before attempting the next breath.
Following the initial five breaths, continuous maintenance rescue breathing must be established until the infant starts breathing normally or professional help arrives. The recommended rate for rescue breathing in an infant with a pulse is one breath every three to five seconds. This translates to approximately 12 to 20 breaths per minute, providing adequate ventilation.
Focus on maintaining a consistent rhythm, delivering a single, gentle breath every time the count of “one-thousand-one, one-thousand-two, one-thousand-three” is reached. The chest should be monitored continuously to ensure each breath is effective. Ineffective breaths necessitate a prompt re-evaluation of the airway position, as the tongue may have obstructed the airflow.
Reassessment and Transition to CPR
While performing rescue breathing, constantly monitor the infant for changes in condition, including skin color and pulse rate. Signs of improved oxygenation include a return of pink color to the lips and nail beds, and potentially a return to spontaneous breathing. Re-assess the pulse approximately every two minutes, taking no more than ten seconds for each check.
The critical threshold to monitor is the pulse rate, as a decline indicates cardiac compromise. If the infant’s heart rate drops below 60 beats per minute, especially with signs of poor perfusion like pallor or cyanosis, immediately transition to full Cardiopulmonary Resuscitation (CPR). A heart rate below 60 beats per minute signals imminent cardiac arrest, requiring chest compressions to maintain blood flow.
The transition to CPR involves alternating chest compressions with rescue breaths, typically at a ratio of 30 compressions to two breaths for a single rescuer. Rescue breathing should only be stopped when the infant begins breathing effectively, when a medical professional takes over care, or when the rescuer is too exhausted to continue. Maintaining the pulse above 60 beats per minute with effective ventilation is the goal until emergency medical services arrive.