As you have read already, there are some differences between performing CPR on an adult versus a child. And when it comes to infant CPR, there are even more differences, as you should now be well aware of after the last section on Infant Landmarks.
Infant-related cardiac arrests are typically the result of:
- Drowning
- Choking/airway obstruction
- Electrocution
Just as with child CPR, due to the nature of these occurrences, providing proper ventilation and oxygenation will be vital for a successful resuscitation.
How to Provide Care
After making sure the scene is safe, that your gloves are on, and that you have your rescue mask with a one-way valve, begin calling out to the victim to assess whether or not the infant is responsive.
Are you OK? Can you hear me? (With infants, shouting their name, if you know it, may help.)
If you don't get an initial response and you can see that the infant still isn't breathing normally, place your hand on his or her forehead and tap on the bottom of the baby's feet. If you still do not get a response, proceed with the following steps.
- Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. In the event that you do not know how to proceed, call 911 on your cell phone, put it on speaker, and follow their instructions.
- Continue to assess the victim's responsiveness and vital signs – signs of breathing normally, signs of a pulse, etc.
- Check for a pulse using the brachial artery, located on the inside of the arm between the bicep and tricep against the humerus bone. Use the flat parts of your index and middle fingers and press on that artery. Spend no more than 10 seconds looking for a pulse.
- If you've determined at this point that the victim is unresponsive, not breathing normally, and has no pulse, continue immediately with CPR.
CPR Technique for Infants
- Draw an imaginary line across the infant's nipples and place two fingers on the lower part of the sternum in the center of the infant's chest. Your fingers should be perpendicular to the chest, meaning your knuckles are directly above your fingers during compressions.
- Stand or kneel directly over the patient's chest. As less pressure is needed when performing CPR on infants, use only your fingers to supply the force for the chest compressions, and count as you perform them.
- Conduct compressions that go to a depth of 1/3 of the infant's chest cavity, which should be around 1.5 inches deep, and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second.
- Perform 30 chest compressions.
- Grab the rescue mask and seal it over the victim's face and nose.
Pro Tip #1: It's important to have a properly sized rescue mask. In other words, one that fits the size of the victim's face. If you have an infant mask, use that. If you don't, there are some tricks to fitting an adult mask onto an infant, such as turning the mask upside down.
- Place something firm under the infant's shoulders to lengthen the neck a little and create a neutral or slightly sniffing head position.
- Breathe into the rescue mask and wait for the chest to rise and fall before administering the next breath.
- Continue to perform 30 chest compressions to two rescue breaths until help arrives, an AED arrives, or the victim is responding positively and breathing normally.
A Word About CPR Compression Rate and Depth
Performing proper chest compressions is essential for providing high-quality CPR, which greatly improves the patient's chances for a successful outcome.
While it's not entirely understood, it's believed that chest compressions increase the level of pressure inside the chest cavity, which squeezes the heart to stimulate a contraction. This helps to send oxygenated blood through the arteries to the brain and other vital organs.
Chest compressions also increase the likelihood of a successful AED shock for the patient, particularly if several minutes have elapsed since the patient collapsed or suffered an incident leading to respiratory distress.
Chest compression effectiveness is reduced if:
- Compressions are too shallow
- The compression rate is too fast or too slow
- There isn't a full recoil of the chest cavity
- There are interruptions during CPR
- The patient isn't laying on a firm, flat surface
Warning: Compression rates that exceed 120 per minute tend to have a negative impact on compression depth, perhaps due to responders rushing through them. Regardless, if compression rate exceeds 120 per minute, you are less likely to compress the full two-inch minimum (for adults), thereby reducing the effectiveness of CPR.
When it comes to compression depth, research suggests that depths greater than 2.4 inches can lead to non-life-threatening injuries, such as broken or fractured ribs.
If you are a novice or unsure if you're compressing at the correct depth, a feedback device might be helpful.