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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 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 ratios can reduce effectiveness and negatively impact survival rates.
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. Getting the balance right between circulatory support and ventilation is important for infants and children.
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 infants in emergency settings. That means for every 30 chest compressions, you should provide 2 rescue breaths at a rate of 100 to 120 compressions per minute to a depth of about 1.5 inches (4 cm) using two fingers or two thumbs.
However, if there are two rescuers, the CPR ratio for infants changes to 15:2, allowing for better quality CPR by distributing tasks between rescuers but it is only taught in the BLS for Healthcare Providers version of CPR. So, if you aren’t a healthcare provider, and trained in two rescuer CPR, just keep it at 30:2.
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.
Importance of High-Quality CPR
In summary, following 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.
Performing each step with precision, at the proper depth and rate, can maximize a child or infant’s chance of survival following a cardiac or respiratory emergency until advanced life support arrives. Remember that compressions are the cornerstone of effective CPR – staying focused on the ratios ensures compressions remain the priority during any pediatric resuscitation effort.
Lastly, if you lack CPR knowledge, we recommend you take a CPR course from Heart Start CPR Training. We are an AHA-certified training center in the U.S.
FAQs on CPR Ratios for Infants and Children
Why do ratios differ between infants and children?
Infant 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?
Strictly following the recommended compression to ventilation ratios is critically important for survival outcomes, as even small deviations can impact blood flow and oxygen delivery. Minor adjustments could reduce cardiac output by up to 50% and double the risk of mortality. Precise timing makes every compression and breath count.