CPR in Children

CPR in Children

Victoria Vetter, MD, FAAP, FACC: Hello, my name is Dr. Victoria Vetter and I'm a pediatric cardiologist and the Director of Youth Heart Watch at the Children's Hospital of Philadelphia. This video will demonstrate how to perform CPR and use an AED on a child from the age of one year to puberty or approximately 12 years of age.

CPR stands for cardiopulmonary resuscitation and is performed by pushing hard and fast in the center of the chest. CPR helps to manually push blood through a person's body when their heart has stopped beating.

An automated external defibrillator, or AED, is a device that reads a person's heart rhythm and can shock or reset the heart to a normal rhythm. Prompt CPR and use of an AED can help save a child's life before emergency medical services arrive.

CPR should be performed when someone is unresponsive, not breathing or not breathing normally, with a gasping or agonal breathing. If a child appears unresponsive, check the child by gently shaking them and shouting, "Hey, hey, are you okay?"

Man: Jimmy, can you hear me?

Victoria Vetter, MD, FAAP, FACC: If they do not respond and are not breathing, have someone call 911 and get an AED immediately.

Man: 911? My child has collapsed. I need help.

Victoria Vetter, MD, FAAP, FACC: If you are alone and witness a collapse, activate 911 and get an AEG yourself, if available, before performing CPR. If you are alone and the collapse was not witnessed, call 911 and put them on speaker phone. If you do not have a cell phone nearby and need to choose between calling for help and starting CPR, start CPR immediately.

Pulse and breathing check. For lay or bystander rescuers, pulse and breathing check is no longer recommended

For healthcare providers, check for breathing and a pulse. Check in the neck for the carotid pulse for no more than 10 seconds. Remove any clothing on the upper body and begin CPR. To begin CPR, lay the child on their back on a flat surface and place one hand over the other, in the center of the chest on the breast bone, just below the nipple line.

Rate and depth of compressions. Put the heel of one hand over the lower end of the breast bone in the center of the chest at the nipple line. Cover with your other hand and interlock your fingers. Straighten your arms and lock your elbows so that your body weight is over your hands. Push straight down at a rate of 100 to 120 beats per minute at a depth of two inches, about one third the depth of the chest.

Count out loud when doing the compressions. Make sure you are not leaning on the chest and that you're allowing the chest to recoil or expand completely after each compression.

Compression breath ratio. For a child, after you give 30 compressions, you should follow the compressions with two rescue breaths. Tilt the child's head back by lifting the chin up, plugging the nose, and giving two breaths. You will see the child's chest rise and fall. Continue the cycle of 30 compressions to two breaths until the child is responsive, our emergency medical services arrive. Compressions on a child with rescue breaths should look like this.

After puberty, witnessed arrest, not related to drowning or respiratory problems such as asthma, may be treated with compression-only CPR.

AED use. Although every AED is slightly different, they are all made to be user-friendly and walk you through the steps. After the AED is on the scene, you will need to open the unit and turn it on. This may happen simply by opening it up or by pushing the on button. Then following the image or voice instructions, put the pediatric pads on the child placing, one on the front of the chest and the other on the back.

If the unit only has adult electrode pads, they are safe to use on a child. Continue CPR until the AED tells you to stop, while it is analyzing the heart rhythm.

AED: Do not touch patient. Analyzing rhythm.

Victoria Vetter, MD, FAAP, FACC: If a shock is advised, the AED will tell you to stand clear and either press the shock button or shock will be automatically delivered by the unit, and you will immediately begin CPR again.

If a shock is not advised, the unit will tell you to continue chest compressions.

After about five cycles, the AED will analyze the rhythm and advise a shock, if needed. Continue CPR in following the AED voice instructions until EMS arrives or until the child regains consciousness.

Do not remove the pads from the child because they might suffer another cardiac arrest before help arrives and need to be shocked again.

Let's review the steps of child CPR and AED use. First, assess the scene and check for responsiveness. Next, call 911 and have someone get an AED. Pulse and breathing check. For lay or bystander rescuers, pulse and breathing check is no longer recommended. For healthcare providers, check for breathing and a pulse.

Begin CPR by pushing hard and fast in the center of the chest 30 times. After 30 compressions, give two rescue breaths and repeat this CPR cycle. If an AED is available, follow the instructions from the unit.