CPR in Infants

CPR in Infants

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 an infant from birth to one year of age when a sudden cardiac arrest occurs. CPR stands for cardio pulmonary resuscitation, which is done 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 or analyzes a person's heart rhythm. When needed, it can shock or reset the heart to a normal rhythm. Prompt CPR and use of an AED can help save a baby's life before emergency medical services arrive.

CPR should be performed when someone is unresponsive, not breathing, or not breathing normally with gasping or agonal breathing. Check for responsiveness. If an infant is unresponsive, check the infant by gently tapping the bottom of the baby's feet or shoulders and shouting, "Baby, baby. Are you okay?" Call 911.

Woman: 911? My baby's not responding. I need help.

Victoria Vetter, MD, FAAP, FACC: If you are alone, put your phone on speaker. 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. Pulse on an infant should be checked in the inside of the upper arm between the shoulder and the elbow -- the brachial pulse. If the infant is not breathing begin CPR. If the infant is breathing and has a strong pulse, wait for EMS to arrive.

Rate and depth of compressions. Lay the infant on their back on a hard, flat surface and use your index and middle fingers to press down in the center of the chest just below the nipple line.

Press down at a rate of 100 to 120 beats per minute, making sure you're reaching a depth of about one and a half inches -- about one third the depth of the chest for -- 30 times. You should count out loud.

Woman: 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30.

Victoria Vetter, MD, FAAP, FACC: Make sure you are not leaning on the chest and you're allowing the chest to recoil or expand completely after each compression. Follow the 30 compressions with two gentle rescue breaths.

Compression ventilation ratio and airway. Tilt the infant's head back by lifting the chin, cover both the nose and mouth with your mouth and give two breaths. Be careful not to overextend the neck. You will see the infant's chest rise and fall.

Continue the cycle of 30 compressions to two breaths until the infant is responsive or emergency medical services arrive. Infant CPR will look like this for a single rescuer.

If there are two rescuers, one can perform CPR using a two-thumb encircling hand position around the chest that looks like this. With two rescuers for an infant, the ratio of compressions to breath is 15 to 2.

Man: 8, 9, 10, 11, 12, 13, 14, 15.

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15.

Victoria Vetter, MD, FAAP, FACC: AED use. If you are in an area where an AED is present or can be retrieved within a few minutes, tell someone to get the AED while you begin CPR.

Woman: Molly's not breathing. I'd call 911. We need the AED.

Man: Ok.

Victoria Vetter, MD, FAAP, FACC: If you are alone and witness the arrest, retrieve the AED immediately, turn it on and follow the voice instructions.

If you are alone and did not witness the arrest, begin CPR immediately and pause to retrieve the AED after two minutes of chest compressions and breaths.

Using an AED is quite simple. 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, open the unit and turn it on. Then following the images or instructions, put the pediatric pads on the infant, placing one on the front of the chest and the other on the back.

If the AED only has adult pads, they can still be used and placed in the same positions, front and back of the chest. Continue CPR until the AED tells you to stop while it is analyzing the heart rhythm. 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.

Begin CPR again after the shock. If a shock is not advised, unit will tell you to continue chest compressions. Continue CPR and follow the AED voice instructions until EMS arrives or until the infant regains consciousness.

Man: 6, 7, 8, 9, 10, 11, 12, 13, 14, 15.

Victoria Vetter, MD, FAAP, FACC: Do not remove the pads from the infant because they might suffer another cardiac arrest before help arrives and need to be shocked again.

Let's review the steps of infant CPR and AED use. First, assess the scene and check for responsiveness. Next, call 911 and have someone get an AED if available. 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 using two fingers to press hard and fast in the center of the chest for 30 compressions. After 30 compressions, give two rescue breaths and repeat this sequence of 30 compressions to two rescue breaths. If two rescuers are present, the ratio is 15 compressions to two breaths. If an AED is available, place the pads in the front and back of the chest and follow the instructions from the unit.

Continue CPR and rescue breaths until EMS arrives.