Life support in infants/children

Technique modifications

• Compression rate: 100–120/minute

• Compression-to-breath ratio

  • Single rescuer: 30:2

  • Two rescuers: 15:2

• Postpubertal children/adolescents: Same CPR technique as for adults

• Children ≥ 1 year of age until puberty

  • Chest compressions: Deliver with one hand for smaller children.

  • Compression depth: 5 cm

• Infants < 1 year old

  • Compression depth: 4 cm

  • Rescue breaths: Form a seal over both the nose and mouth.

• Defibrillation

  • Children 1–8 years old: If available, use an AED with pediatric attenuation (if no other device is available, use an adult AED).

  • Infants < 1 year old: If available, use a manual defibrillator (if no other device is available, use an adult AED). [39]

• Initial steps (identical to BLS algorithm for adults): Assess scene safety and patient responsiveness, and call for help.

• Check for signs of life

  • Pulse present, no breathing

    • Administer rescue breaths: 1 breath every 2–3 seconds (20–30 breaths/minute)

    • If heart rate is ≤ 60 beats/minute: Start CPR.

  • No pulse, gasping, or no breathing: Start CPR.

• Single rescuer sequence

  • Perform 2 minutes of CPR (30:2 with a compression rate of 100–120/minute) before calling for help or retrieving an AED (if it requires leaving the patient's side).

  • If a cell phone is available, make an immediate emergency call and perform CPR with the phone on speaker.

• Two-rescuer sequence

  • Direct the second rescuer to call for help and retrieve a defibrillator.

  • Start CPR at a ratio of 30:2, changing to 15:2 when both rescuers are able to provide CPR.

• Rhythm assessment and defibrillation

  • Shockable rhythm: Defibrillate using pediatric AED pads for children 1–8 years old and continue CPR.

  • Nonshockable rhythm: Continue CPR immediately.

• Endpoints: identical to BLS algorithm for adults.

• Compression rate: 100–120/minute

• Compression-to-breath ratio: 3:1 (as hypoxia is the most common cause of arrest in neonates).

• Chest compression technique in neonates

  • Single rescuer: two-finger technique

    • Perform chest compressions using two fingers (the index and middle fingers) on the lower half of the sternum, just below the intermammary line.

    • Allows for faster changes between compressions and delivering breaths if only a single provider is present

  • Two rescuers: two-thumb-encircling hands technique

    • One rescuer performs chest compressions while the other delivers breaths.

    • Encircle the chest with both hands, with the thumbs placed over the lower third of the sternum.

    • Compress the lower sternum with both thumbs.

    • Results in more effective compressions and higher coronary artery perfusion than the two-finger technique