Main Takeaway:
According to AHA guidelines, the recommended compression-to-ventilation ratio for infants and children is 30:2 for a single rescuer and 15:2 for two rescuers.
Performing cardiopulmonary resuscitation (CPR) on infants and children requires using the proper compression-to-ventilation ratios. Getting the ratios right is critically important for giving these small patients the best chance of survival during a cardiac or respiratory emergency. This article provides evidence-based recommendations on compression to ventilation ratios for babies and pediatric patients, along with answers to frequently asked questions.
Why CPR Ratios Matter?
High-quality CPR is key to survival after cardiac arrest. The compression-to-ventilation ratios prescribed in CPR guidelines are designed to optimize blood flow and oxygen delivery to the heart and brain during an emergency. Deviating from the recommended CPR ratios can reduce effectiveness and negatively impact survival rates. The compression-to-breath ratio varies depending on the age of the child and whether there is one rescuer or two rescuer performing CPR.
For example, delivering too many ventilations and not enough compressions decreases critical blood flow. Conversely, focusing too much on compressions without enough ventilation risks overlooking a respiratory cause that may require support with rescue breathing. The correct infant and child ventilation rate is crucial to maintain a balance between circulatory support and oxygenation.
Recommended Compression to Ventilation Ratios for Infants (Under 1 Year)
The 2020 American Heart Association (AHA) CPR guidelines recommend a 30:2 compression-to-ventilation ratio for both infants and children in emergency settings when a single rescuer is performing CPR. For infants, this means 30 chest compressions to 2 rescue breaths at a rate of 100 to 120 compressions per minute, with a depth of about 1.5 inches (4 cm) using two fingers or two thumbs.
For children, the same 30:2 ratio applies if a single rescuer is performing CPR.
However, if there are two rescuers, the compression-to-ventilation ratio for infants changes to 15:2, allowing for better quality CPR by distributing tasks between rescuers. This change is taught in the BLS for Healthcare Providers version of CPR. So, if you aren’t a healthcare provider and haven’t been trained in two-rescuer infant CPR, just keep it at 30:2.
Also read: One rescure infant CPR ratio
Recommended Compression to Ventilation Ratios for Children (1-8 Years)
The current AHA CPR guidelines also recommend a 30:2 compression-to-ventilation ratio for a child. This involves giving 30 compressions followed by 2 rescue breaths that make the chest clearly rise.
The compression rate should be at least 100-120 chest compressions per minute. For two-rescuer pediatric CPR, the compressing rescuer should perform continuous 15 compressions without pausing while the other rescuer gives 2 breaths which is believed to be more effective, potentially reducing the efficacy of the CPR being performed.
Also Read: What is the Correct Ventilation Rate for a Pediatric Patient in Respiratory Arrest?
Importance of High-Quality CPR
High-quality CPR plays a crucial role in saving pediatric patients. The recommended 30:2 compression-to-ventilation ratio for both infants under 1 year and children aged 1-8 years is crucial for pediatric CPR. This balances compressions to drive blood flow with the ventilation needed to provide oxygen without significant pauses in chest massage.
This method helps minimize interruptions in chest compressions, which is vital for preserving brain and organ function. High-quality CPR not only supports the appropriate ventilation rate but also significantly increases the chances of survival for an infant or child during a cardiac or respiratory emergency, until emergency medical services (EMS) arrive.
Effective chest compressions and use of an AED are the foundation of successful CPR. By staying focused on the recommended ratios, rescuers can ensure that compressions remain the top priority during any pediatric resuscitation attempt.
How to Avoid Common Mistakes in Infants and Children when performing compression?
It is very important to avoid common mistakes in infant and child CPR because there is a high chance of increasing the survival of the victim from a life-threatening situation. Here are the tips to avoid mistakes while giving CPR to infants and children:
1. Know the Correct Compression-to-Ventilation Ratio:
The correct compression-to-ventilation ratio for infant and child CPR depends on the number of rescuers:
- Single Rescuer: Perform 30 chest compressions followed by 2 rescue breaths (30:2 ratio).
- Two Rescuers: Perform 15 chest compressions followed by 2 rescue breaths (15:2 ratio
2. Maintain Correct Hand Placement:
While providing CPR, make sure to maintain correct hand placement. Use two fingers just below the nipple line for infants, and one or two hands on the center of the chest for children.
3. Avoid Interruptions:
Minimize pauses during chest compressions to maintain blood flow. Continuous chest compressions keep oxygen-rich blood flowing to the brain and heart, which is essential for a higher chance of survival. When giving rescue breaths, be sure to observe for a visible chest rise to confirm air is entering the lungs.
4. Use an AED Quickly and Correctly:
While performing CPR on an infant or child, don’t delay in providing an automated external defibrillator PAD placement correctly on infant and child because early defibrillation increases the survival rate.
Take a certified CPR course
Before stepping into the role of a rescuer, it’s essential to know how to properly perform CPR on both infants and children. Hands on training and the use of high-quality CPR tools such as an oxygen mask, bag valve mask ventilation, and an AED allow you to learn the correct techniques that can make a life saving difference in real life emergencies.
It can be very challenging to find the right CPR training center in San Francisco. Heart Start CPR provides AHA-certified courses. We recommend enrolling in a Pediatric Advanced Life Support (PALS) class to learn survival skills and the compression-to-ventilation ratio. We also offer Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS) courses, taught by highly qualified and professional instructors.
Enroll now and get certified and enhance your confidence while saving a child’s life in an emergency!! Here is the PALS study guide, which helps you to review key concepts.
FAQs on CPR Ratios for Infants and Children
Why do ratios differ between infants and children?
Infant cpr and child CPR techniques differ based on anatomical and physiological factors like thoracic cavity size, airway patency, and blood circulation patterns. Infants have smaller chests that fill more easily with a single breath. Children have bigger chests requiring more compressions to circulate blood and empty more with each rescue breath.
Why do compressions matter more than breaths for CPR?
Chest compressions generate blood flow to vital organs like the heart and brain when a person’s heart is not pumping effectively. Keeping circulation going is the primary goal of CPR, especially in the first critical minutes after cardiac arrest. While ventilation is important, blood flow provided through high-quality, minimally interrupted compressions is most closely associated with ROSC (return of spontaneous circulation) and survival.
How important is it to get the ratios right?
Getting the recommended CPR ratio right is crucial for survival outcomes. Even slight deviations from the infant CPR ratio can impact blood flow and oxygen delivery, reducing cardiac output by up to 50% and doubling the risk of mortality. The correct compression depth is equally important, as compressions should be about 1.5 inches (4 cm) for infants. Every compression and breath must be timed precisely to ensure they’re as effective as possible.
What is the rate of CPR for infants?
The American Heart Association recommends a rate of 100 to 120 compressions per minute for infant CPR. To perform chest compressions correctly, administer 30 compressions followed by two rescue breaths. Continue this cycle until the infant shows signs of life or an emergency responder arrives to take over. It’s essential to perform compressions quickly and rhythmically, similar to the beat of the song “Stayin’ Alive.”
