Infant Chest Compressions
Chest compressions in an infant can be done with two thumbs or two fingers depending on your need to move the infant.
If the infant is on a hard flat surface, and does not need to be moved, wrap both of your hands around the chest of the infant with your thumbs resting on the lower half of their breastbone. At the same time press both of your thumbs into the infant’s chest about 1/3 the depth of their chest at a rate of 100-120 compressions a minute fully releasing pressure between compressions.
If you need to move the infant, rest them on your arm supporting their head in the palm of your hand. With your other hand place your index and middle finger over the lower half of their breastbone. Compress their chest about 1/3 the depth of their chest at a rate of 100-120 compressions a minute fully releasing pressure between compressions.
Infant Rescue Breathing
One of the main reasons children and infants go into cardiac arrest is respiratory failure. That is to say, rescue breathing in children and infants is extremely important. This rescue breathing allows you to replace depleted oxygen in the victim’s blood. Two options of rescue breathing are mouth-to-mouth and bag-valve-mask. With either technique, you will want to provide two breaths stopping once you notice chest rise for every thirty chest compressions.
Compression-to-Ventilation (CV) Ratios
If you’re acting as a single rescuer you should perform a compression-to-ventilation or CV ratio of 30:2. That means after 30 chest compressions you should perform two rescue breaths.
However children and infants have a higher baseline demand for oxygen and low oxygen is a leading cause of pediatric cardiac arrest. That means if you have multiple rescuers and can effectively do it you should utilize a CV ratio of 15:2. **That means if you have multiple rescuers you should deliver 2 breaths after every 15 chest compressions.
Infant Mouth-to-Mouth
Place your mouth over the infant’s mouth and nose forming a seal
Tilt their head slightly back without going too far
Exhale while watching for and stopping when you notice chest rise
Allow the infant to exhale and deliver one more breath while watching and stopping for chest rise
Infant BVM
Place the infant BVM mask over the nose and mouth to form a seal without excessive pressure which could compress the infant’s airway
Tilt their head slightly back without going too far. You may consider placing some padding under the infant’s shoulders instead.
Deliver one breath over one second (stopping when you note chest rise)
Release the bag over one second allowing the infant to exhale -Deliver one more breath over one second (stopping when you note chest rise)
Infant AED
AED’s are to be implemented immediately upon availability during your chest compressions and rescue breaths. The person delivering the AED should be directed to work around the chest compressor to deploy the AED.
Most AEDs have separate pads or modes for children and infants to deliver a lower energy. If present and able, use the child pads or child AED mode. If unavailable, you may use adult pads/mode on a child or infant.
Some cardiac arrests are caused by disorganized electrical activity within the heart. In these specific cases resetting the electrical system of the heart can restore organized and coordinated electrical activity restoring the circulation of blood. The AED is able to determine these types of cardiac arrest, and restart the heart by sending a large impulse of electricity through the heart.
To operate an AED follow these three steps:
Turn AED On
Place Pads on Victim
Follow AED Prompts
Make sure to avoid touching the patient while the AED is analyzing and during shock delivery.
For an infant, place one pad on the center of their chest over the breastbone with the other pad placed on the center of their back opposite of the first pad. Make sure to avoid overlapping the pads.
Infant Team CPR
If you have multiple rescuers one person should establish themselves as a team coach. The role of the team coach is to ensure all important steps are being taken effectively and to promote effective communication. An effective team coach will:
Identify and designate a person to activate 911 and ensure responders have access to the area
Identify and designate a person to perform chest compressions and switch them every two minutes
Provide encouragement and coaching to the chest compressor if/when necessary -Identify and designate a person to retrieve the closest AED and deploy it
All of the steps of CPR need to be performed and having a team with a team coach allows a resuscitation to happen quicker and with greater efficiency.
Infant Choking
Infants may choke for any number of reasons. It is important to quickly identify a choking infant and respond appropriately. A choking infant may or may not appear in distress. You may not hear breathing sounds or crying in an infant that is choking. You may notice their skin changing to a blue color especially around the lips and fingernails.
If choking relief fails and the infant becomes unresponsive, start CPR.
Infant Back Thrusts
To rescue a choking infant you should place your arm along their chest supporting their head without blocking their airway. Tilt the infant downwards and slap their back between their shoulder blades five times using a forceful and brisk movement. Then roll the infant supporting their body with your arm and tilting their head downward to provide five chest compressions. You will repeat this process until the object becomes clear. If the infant becomes unresponsive, you should start CPR immediately.
Don’t forget to call 911 when possible!
Review
Where do you place your hands in infant CPR?
How deep do you compress in infant CPR?
How many times in one minute do you compress in infant CPR?
How many compressions are performed before delivering two breaths in infant CPR?
How should the AED pads be placed on an infant?
Can you use adult pads on an infant?