Once you have learned the basics of the Adult CPR Guidelines, learning the few minor differences for infants is easy and only takes a few moments. Having a strong foundation by learning the basics is essential. I will focus on the key differences between the adult and child guidelines. An infant is a child under the age of one.
Checking for Consciousness
Gently stroke the infant and watch for the infant to move or tap on the infant’s foot. Never shake and infant, as for they are at risk for shaking baby syndrome which can result in severe brain damage with devastating consequences. If there is no response, immediately check for a pulse and initiate compressions if required.
Activation of EMS
With infants, the majority of cardiac arrests are secondary to a respiratory complication and therefore when an infant is initially found, the rescuer should provide 5 cycles or 2 minutes of CPR before pausing to activate the EMS system and obtaining an AED. In a hospital or healthcare environment, activation of CPR and notifying others will happen simultaneously.
If the infant is in the nursery, try and move the infant to an area where you have space to work and close the blinds to avoid other parents and visitors from observing this clinical emergency. Crowd control is a huge issue when an infant requires assistance because everyone is curious and wants to help. In general, assign one person to be in charge of crowd control. A general rule is that if someone is not actively participating in the code, then they need to leave the area, otherwise confusion will ensue.
Also, remember to assign someone to keep the parents informed, especially if they are watching the actual code, which often occurs these days; parents are not immediately escorted out of the room anymore, as there is data demonstrating that if the child does not survive, parents often cope better knowing that all efforts were made to save their infant’s life. Of course, this will vary on a case-by-case basis.
When performing CPR, you will be providing oxygen to the brain, heart, and other vital organs. Therefore, implementing your efforts quickly will decrease the likelihood of organ damage from the lack of oxygen.
- For the pulse checks, the provider can check for a brachial or femoral pulse. If a pulse if present, count for a full minute. If the pulse is absent or leas than 60 beats per minute initiate compressions.
- For infants, a single rescuer will use two fingers for compressions on the chest just below the nipple line. If two rescuers are present then the rescuer should use the two thumbs – encircling hands technique. The depth of the compressions should be about 1.5 inches depending on the overall size of the infant. The goal is to compress the chest by 1/3.
- The compression to ventilation ratio will be the same as an adult for a single rescuer (30:2). However, if two rescuers are present, the compression to ventilation ratio changes to 15:2. The goal is to do about 100 compressions a minute.
Automated External Defibrillator (AED)
Apply after 5 cycles of CPR if there is no response.
- Use a manual defibrillator if available
- If a manual defibrillator is not available, use the pediatric attenuated system (pediatric sized pads)
- If neither are available, use the standard AED.
- On an infant, one pad will be placed on the chest and the second pad will be placed on the back.