Infant Cardiopulmonary Resuscitation (CPR)

Although cardiac arrest is uncommon in infants, it does occur. Most non-traumatic infant cardiac arrests are related to some form of asphyxia (suffocation) or respiratory ailment. This means they are likely to respond favorably to rescue breathing when it is part of the resuscitation attempt. Regardless of the cause of the cardiac arrest situation, all unresponsive infants should receive CPR including rescue breathing until reaching the hospital when at all possible. Infants are very resilient and can often be resuscitated after several minutes without spontaneous respirations in non-traumatic medical emergencies.

A baby is considered to be a newborn from one-day-old to one-month-old and an infant from one-month-old to one-year-old.

Remember: Check the scene for hazards first; the infant second!

If an infant is found to be unresponsive, not breathing, or ineffectively breathing (gurgling), it is crucial to assess their level of consciousness by gently tapping/flicking the bottom of their feet in an attempt to arouse them. If you aren't able to arouse the infant, and there are no obvious signs of life such as crying and/or spontaneously moving, immediately begin CPR with rescue breathing.

Call for Help - 911!

If you are alone with an infant, begin CPR immediately for two minutes (5 cycles of 30 compressions and 2 breaths) before leaving the infant to call 911. Infants are portable, so you can carry an infant with you to call 911 if needed, as long as the infant HAS NOT suffered a spinal injury.

Always combine universal precautions with the appropriate
personal protective gear before initiating first aid and/or CPR on ANYONE!

The minimal universal precaution requirements for conducting CPR on any person of any age consist of protective exam gloves and the use of a barrier device when mouth-to-mouth rescue breathing is used

Employ C, A, B, D: Compressions - Airway - Breathing - Defibrillation

According to the National CPR Standards, infant CPR should be conducted on any child under the age of one year.

First - Check for consciousness by tapping or tickling the bottom of the infant's foot and making noise.
No Response?

• 1. Quickly position the unresponsive infant so they are lying flat on their back on a solid surface (preferably the floor) that won't give when compressions are delivered (not a bed or sofa).

Compressions

• 2. Position yourself beside the infant, as you would for any other victim.
• 3. Proper placement for chest compressions on an infant is just below the nipple line. The easiest way to find the correct placement for chest compressions on an infant is to place three fingers in the center of the infant's chest with the top finger between the nipples. Raise your top finger and your two remaining fingers will then be in a perfect position right below the nipple line. Just above the little notch at the bottom of the infant's sternum. If you feel the notch with any of your compression fingertips, move them up slightly toward the head.
   
  
• 4. After finding the proper finger placement on the center of the infant's sternum, place your other hand on their forehead to help stabilize the head during CPR. Now you have the proper finger compression location and the head stabilized.
• 5. Administer 30 chest compressions on an infant at 1.5 inches deep (1/3 their chest diameter). The most recent CPR guidelines recommend that chest compressions be delivered "fast-n-hard" at a depth that maximizes blood flow without causing injury. This holds true for infant CPR as well, but it doesn't take nearly the force to deliver high-quality compressions on an infant as it does for an adult. Ensure your compressions are delivered smoothly, not with stiff, rigid, or spastic motions. Infant's bones are pliable but will fracture if too much external pressure is applied. If the compressions are not smooth and fluid-like, the amount of blood (therefore oxygen) reaching the end-organs will be greatly reduced.
   
  
• 6. Ensure you release the pressure on the infant's chest between compressions to allow the chest wall to recoil. However, do not take your fingers off the victim's chest to prevent having to locate the proper location again. Keep a smooth steady rhythm and don't create a pause between compressions.
  Remember: deliver 100 to 120 chest compressions/minute. Keep compression delays to a minimum.

Airway

• 7. Opening the infant's airway is safely accomplished by applying a gentle head-tilt/chin-lift maneuver. The airway must be open so that air can enter and exit the lungs. The tongue is the most common airway obstruction in any unconscious victim and can prevent adequate airflow during CPR. While a person cannot swallow their tongue, it can flop backward if they become unconscious and essentially block air from entering the lungs.
   
  

Breathing

• 8. Once the victim's airway is properly open with the head tilt/chin lift, ensure the barrier device is in place before delivering the first rescue breath. To properly deliver a breath to an infant, simultaneously cover their nose and mouth with your mouth. It should take about a second to fill the victim's lungs and about a second for exhalation to occur naturally. Repeat the rescue breath once more before proceeding with the next cycle of 30 chest compressions.

Note: Remember, the cause of most cardiac arrest situations involving infants and children results from some type of respiratory component. Therefore, conducting high-quality, "fast-n-hard" CPR including the rescue-breathing portion of the life-saving intervention gives the infant the greatest chance of surviving the event.

• 9. Continue the resuscitation attempt following the latest recommended CPR guidelines for infant AED, chest compression, and rescue breathing until:
  • - The victim shows obvious signs of life such as breathing or spontaneously moving
  • - Another person with higher training arrives to take over care of the victim
  • - Physical exhaustion or injury prevents continuing the resuscitation effort
  • - It becomes too dangerous for the resuscitation attempt to continue safely

Defibrillation

• 10. Most newer model AEDs are designed to deliver the normal defibrillation energy levels to adults or children depending on the specific size pad selected and attached by the rescuer. Pediatric pads are specifically designed for children and are recommended as they deliver lower energy levels to infants and children up to eight years/weighing less than 5 -pounds. However, if the AED doesn't have pediatric-specific pads, it is acceptable and recommended to use adult pads rather than withholding defibrillation. Always follow the manufacturer's recommendations concerning the proper operation of the unit.

AED Operation:

• Turn the AED on. (The power-up button is normally highly visible and easy to find; some units automatically turn on when the case is opened.)
• Gently but quickly expose the infant's entire chest.
  (Ensure their chest is clean and dry; never apply alcohol to clean a victim's chest during a resuscitation attempt.)
• Properly separate the pad's adhesive backing and apply one pad to the chest and one pad to the infant's back (between the shoulder blades).
• Attach the cables to the pads, if it is necessary to do so. Some units have one-piece cables that are always attached to the unit.

At this point; No one should be touching the victim!

• Some newer models can evaluate the rhythm automatically when the pads are attached to the cables without the rescuer prompting the unit to do so. If so, most have voice prompts alerting the rescuer of the pending analysis. Other units have big (usually red) buttons that must be manually triggered to initiate the analysis procedure. The button is normally clearly marked "analyze." Regardless of how the analysis procedure is initiated, all victim contact must cease and the rescuer should clearly announce "Clear, Stand Clear" (or something similar that clearly warns all nearby to not touch the victim). It will not injury a person if they are touching the victim during the analysis phase, but it can create a faulty reading that leads to improper treatment of the victim. The readings are so sensitive they can detect the pulse of anyone touching the victim and withhold a possibly life-saving defibrillation attempt.

If the AED determines a Shock is indicated

• Ensure that you and everyone else are clear and all victim care procedures are stopped temporarily.
• Announce loud and clear, "Clear, stand clear; everyone clear" (or something similar that clearly announces your intention to initiate a shock to the victim).
• Visually re-confirm that no one is in contact with your victim at all.
  (Re-confirm that you are clear as well; it is easy to be so concerned with everyone else that you don't notice that you are touching the victim–safety first!)
• Some newer models have an automatic defibrillation feature while other older AED units require the rescuer to push a button (often red) clearly marked for defibrillation

Post-Shock/No-Shock Procedure

• Initiate or continue high-quality, "fast-n-hard" CPR.
  (Remember: 100 to 120 compressions/min. for everyone as of 2015)
• Follow the AED prompts while continuing CPR and awaiting EMS arrival.

Let’s Review Infant CPR

First:

Check the scene for potential hazards and to ensure your safety. Do not become a victim yourself!

Then:

C – Check the infant's level of consciousness by flipping/flicking/stimulating the bottom of his/her feet.

P – Phone for help or get someone else to do it for you while you initiate care on the unresponsive infant.

R – React to the life-threatening event by initiating the proper intervention such as CPR (Remember: CABD).

CPR Guideline Update
Important Points about Infant CPR
Infant Resuscitation

• Deliver 30-chest compressions at 1.5 inches deep (1/3 the infant’s chest diameter).
• Administer at least 100 to 120 chest compressions/minute with minimal interruptions.
• Deliver 2-rescue breaths through an approved barrier device after every 30 chest compressions.
• A rescue breath takes about one second to adequately fill an infant's lungs and causes adequate chest rise to take place (Infants must be ventilated with gentle puffs of air due to the potential for lung injury).

Continue CPR cycles until:

• The infant shows obvious signs of life such as breathing or spontaneous movements.
• The AED is prepared for analysis or defibrillation.
• EMS arrives to take over care of the victim. (Care should continue until advised to stop by EMS.)
• The scene becomes unsafe for you to continue care.
  (However, infants are highly portable and can leave the area with you if the situation requires it, in most cases)

Congratulations!

You have completed the infant CPR material. If you are comfortable with the presented material, feel free to continue to the compression-only CPR section.