Performing cardiopulmonary resuscitation (CPR) on an infant requires precise knowledge of techniques, including the correct compression to ventilation ratio. This ratio determines how many chest compressions are delivered in relation to breaths, ensuring the baby receives enough blood flow and oxygen during cardiac arrest. Because an infant’s body is more fragile and their heart-related emergencies often stem from respiratory problems, rescuers must adjust both the pressure and timing of compressions and ventilations accordingly. Understanding the correct compression to ventilation ratio for infants can be the difference between life and death in an emergency situation.
Understanding Infant CPR
Infant CPR is designed for babies under one year of age, excluding newborns in the delivery room. Their smaller anatomy, faster heart rates, and unique physiology mean that CPR guidelines differ from those for children and adults. The main goals remain the same keep blood flowing to the brain and heart while providing oxygen through ventilations.
Why the Ratio Matters
The compression to ventilation ratio ensures the rescuer strikes the right balance between maintaining circulation and delivering breaths. Too many compressions without adequate ventilation can leave the body oxygen-deprived. Too much focus on breaths without sufficient compressions can lead to reduced blood flow to vital organs.
Standard Compression to Ventilation Ratios
The recommended ratio varies depending on the number of rescuers and the training level of those providing care.
Single Rescuer
When only one rescuer is present, the ratio for infant CPR is typically
- 30 compressionsfollowed by2 breaths
This guideline helps maintain an efficient rhythm, minimizing interruptions in chest compressions while still delivering essential breaths.
Two Rescuers
When two trained rescuers are available, the ratio changes to
- 15 compressionsfollowed by2 breaths
This allows for more frequent breaths since one rescuer can focus solely on compressions and the other on ventilations. This is particularly important for infants because respiratory failure is a more common cause of cardiac arrest than primary heart problems.
Performing Compressions Correctly
Chest compressions for infants differ from those for adults, both in hand placement and force applied.
Hand Positioning
For a single rescuer
- Use two fingers (index and middle) placed just below the nipple line on the breastbone.
For two rescuers
- Use the encircling hands technique, placing both thumbs on the breastbone while the fingers support the infant’s back.
Compression Depth and Rate
Compressions should be about 1.5 inches (4 cm) deep, at a rate of 100-120 compressions per minute. Allow the chest to fully recoil between compressions to promote blood flow.
Delivering Effective Ventilations
Ventilations are equally critical in infant CPR, especially since many cardiac arrests are secondary to breathing problems.
Technique
- Cover both the infant’s mouth and nose with your mouth to create a seal.
- Deliver a gentle breath over about one second, just enough to see the chest rise.
- Avoid giving excessive breaths or force, which could cause lung injury.
Frequency
Follow the appropriate compression to ventilation ratio based on whether you are alone or with another rescuer. Keep interruptions to compressions as short as possible.
Special Considerations for Infants
Because infants have higher oxygen demands and lower oxygen reserves, delays in ventilation can lead to rapid deterioration. This is why, in many infant CPR cases, breaths take on a greater role than in adult CPR.
Common Causes of Cardiac Arrest in Infants
- Severe respiratory infections
- Choking or airway obstruction
- Sudden Infant Death Syndrome (SIDS)
- Congenital heart defects
- Trauma
Checking Responsiveness and Breathing
Before starting CPR, check if the infant is responsive by gently tapping their foot or shoulder and calling their name. If there is no response and no normal breathing, begin CPR immediately.
Differences from Adult CPR
While the basic concept of CPR is similar across all age groups, key differences for infants include
- Smaller hand positioning area
- Shallower compression depth
- Higher priority on ventilation due to common respiratory causes
- Different compression to ventilation ratios for single and two-rescuer scenarios
Common Mistakes to Avoid
Even trained rescuers can make errors that reduce the effectiveness of CPR. Some common mistakes include
- Pressing too hard or too shallow during compressions
- Failing to allow full chest recoil
- Delivering breaths that are too forceful
- Incorrect hand placement leading to ineffective compressions
- Prolonged pauses between compressions and breaths
Training and Practice
Learning infant CPR and the correct compression to ventilation ratio is best done through certified training programs. Practicing on manikins helps build muscle memory, making it easier to perform correctly during an actual emergency.
Why Regular Refresher Courses Are Important
Guidelines for CPR are updated periodically based on new research. Regular retraining ensures rescuers are using the most current techniques and ratios.
Role of Emergency Services
While CPR can keep an infant alive until advanced help arrives, it is not a replacement for professional medical intervention. Call emergency services immediately before starting CPR if possible. If alone, perform two minutes of CPR before calling, unless you can activate emergency services via speakerphone without stopping CPR.
The compression to ventilation ratio for infants plays a crucial role in effective CPR. For a single rescuer, the ratio is 302, while for two rescuers, it is 152. Understanding these ratios, along with correct hand positioning, compression depth, and ventilation technique, can greatly improve the chances of survival. Regular training and practice ensure that rescuers can act quickly and confidently when faced with a life-threatening emergency involving an infant.