Notes

High-Quality Pediatric CPR

Foundational Concepts of High-Quality CPR
To review, the foundational concepts of high-quality CPR include the following:
1. Start chest compressions within 10 seconds of recognition of a cardiac arrest.
2. Chest compressions should be hard and fast.
3. Allow complete chest recoil after each compression.
4. Minimize interruptions during chest compressions.
5. Give effective rescue breaths.
6. Avoid excessive ventilation.

Procedure for Performing High-Quality CPR
The main steps in performing pediatric high-quality CPR are the same as the adult procedure. They are:
1. Position the victim.
2. Provide chest compressions.
3. Give two rescue breaths.
4. With two rescuers, switch compression roles every two minutes.
5. Continue CPR until it is appropriate to stop.

Step 1 - Position the Victim
If needed, place the victim on a firm, flat surfaces, such as a backboard or the floor. Chest compressions are more effective when performed on a firm, flat surface.
- Make sure the victim is in the supine position. If needed, carefully roll the patient over.
- In all cases, if you suspect a spinal injury, try to keep the head, neck, and torso aligned when moving or rolling the victim.

Step 2 – Provide Chest Compressions
Providing compressions can cause fatigue and reduce the quality of the compressions. So, using the proper technique will reduce fatigue and allow you to perform high-quality CPR for a longer time.
Depending on the number of rescuers and the age of the victim you will provide different types and numbers of chest compressions.

Step 2 – Provide Chest Compressions (continued)
Chest Compressions on a Child
Chest compressions on a child are generally performed the same as adult chest compressions with a few exceptions:
1. Remove all clothing covering the victim’s chest.
2. Put the heel of one hand in the center of the victim’s chest on the lower half of the sternum, or breastbone. Interlace the fingers of your other hand on top of the first.
- For smaller children you may only need one hand. In this case, place the unused hand by your side. replay
3. Position your shoulders directly over your hands. Straighten and lock your elbows. Perform chest compressions by pushing straight down, hinging at the hips. replay
- Compress the chest to a depth of about one-third the anterior-posterior diameter of the chest, about 2 inches (5 centimeters). replay
4. Allow the chest to recoil completely.
5. For a one-person rescue, provide 30 chest compressions at a rate of 100 to 120 per minute, which takes 15 to 18 seconds.
-For a two-person rescue, only provide 15 chest compression at a rate of 100 to 120 per minute, which takes 8 to 9 seconds. Fewer compressions per cycle allows you to give more rescue breaths over the duration of the emergency which is important during a pediatric cardiac arrest.

Step 3 – Give Two Rescue Breaths
When cardiac arrest occurs in infants and children it is often a secondary effect of respiratory issues. This means there is a reduced oxygen content in the blood. Therefore, it is important to deliver both chest compressions and rescue breaths during high-quality CPR.
Because rescue breaths are so important, the chest compression to rescue breath ratio is reduced from 30:2 with a one-person rescue to 15:2 when two rescuers are present. This means rescue breaths are delivered twice as often.
Note: A one-person rescue cannot effectively give rescue breaths at a ratio of 15:2 because it takes too much time switching back and forth between compressions and breaths.
The procedure for giving infant and child rescue breaths is the same as giving adult rescue breaths.

Step 4 – With Two Rescuers, Switch Compression Roles Every Two Minutes
Just like in adult CPR, compressions may cause fatigue. So, when two rescuers are performing CPR, they should switch positions about every two minutes, or five cycles of compressions and rescue breaths.
This switch should take less than 10 seconds. The rescuer performing chest compressions should call for a switch at the beginning of the cycle.

Step 5 – Continue CPR Until It Is Appropriate to Stop
Rescue Breathing and Barrier Devices
A barrier device should be used to protect the rescuer from contact with the victim’s exhaled air or fluids. Two popular types of barrier devices are the pocket mask and the bag-mask.

Using a Pocket Mask
When there is one rescuer, it is best to use a pocket mask. It is easier to switch between chest compressions and rescue breaths using a pocket mask. Use the same pocket mask procedure as an adult.

Using a Bag-Mask
Generally, when there are two or more rescuers, it is best to use the bag-mask. This is because a bag-mask can deliver more oxygen to the victim. If a bag-mask is not available, then use a pocket mask. Use the same bag-mask procedure as an adult.

Mouth-to-Mouth for Children
If a barrier device is not available and the victim is a child, use the same mouth-to-mouth procedure as an adult

Mouth-to-Mouth-and-Nose for Infants
If a barrier device is not available and the victim is an infant, use mouth-to-mouth-and-nose rescue breaths. This is where the rescuer simultaneously covers the victim’s mouth and nose. If the rescuer cannot completely cover the infant’s mouth and nose, then use the mouth-to-mouth technique instead.

Steps for the mouth-to-mouth-and-nose rescue breaths are:
1. Open the victim’s airway using the head-tilt/chin-lift technique. replay
2. Take a normal breath and seal your mouth over the victim’s mouth and nose.
3. Blow into the victim’s mouth delivering 1 rescue breath over 1 second while watching for a chest rise.
4. Break the seal and take a normal breath before re-sealing your mouth and delivering another rescue breath.