Do you know about lifesaving emergency techniques to follow if your child is not breathing? Do you spend most of your time with kids or work in a childcare center? If yes, here is what you need to know to prevent any cardiac emergencies.

Cardiac arrest is an emergency condition & the rates are very high among the pediatric population. The incidence rate is 6-10 per 100,000 children per year & only with a 10% survival rate. Child caretakers, parents & health workers should be fully aware on cause of CPR and steps for giving CPR to an infant in emergency situation.

Cardio-pulmonary resuscitation is a lifesaving emergency procedure that involves breathing for the child & applying external chest compression to make the heart pump. It is done in emergencies when the child’s heart suddenly stops working.

Purposes for Cardiopulmonary Resuscitation (CPR)

• To immediately restore the supply of blood to the heart.
• To prevent permanent damage to heart & brain tissues.

What is the condition to perform CPR?

The condition to perform CPR is Cardiac arrest, a is a critical condition characterized by the loss of heart function, which can occur in children with previously diagnosed or undiagnosed heart disease.

• It is a condition of loss of heart functions in a child who previously has been diagnosed or undiagnosed with heart disease.
• It is the condition when the heart cannot pump blood to meet the body’s demands.

The signs are sudden unresponsiveness & not breathing. Infants who are born with congenital heart diseases are more prone to cardiac arrest. 25% of deaths from cardiac arrest occur in children with congenital heart disease.

What are the 5 basic steps of infant cardiopulmonary resuscitation?

• Follow the ABCDE method in the initial assessment & systemically perform the sequence of resuscitation.
  • A:  Airway
  • B: Breathing
  • C: Circulation
  • D: Disability
  • E: Exposure

• Perform the assessment in sequence.
• During airway assessment, check for breath sounds or check for the rise of the child’s chest.
• For breathing, check for wheezing, grunting & crackles. If you have pulse oximetry, use it to check the child’s saturation. Normal oxygen saturation is 94% or more in the room air.
• Check the pulse, heart rate, and skin color for circulation.
• To assess disability, check the pupil’s size & responsiveness.
• For exposure, prevent a child from hypothermia.

• Use SAFE approach.
  • S: Shout for help
  • A: Approach with care
  • F: Free from danger
  • E: Evaluate ABC.

what are the 5 steps for giving CPR to an infant ?

1. Check for child responsiveness.
2. Airway assessment & management
3. Breathing assessment & management
4. Circulatory assessment
5. Continue CPR

Step 1: Check for the child’s responsiveness

• Asking the child loudly, ‘Are you alright?’ or calling out for the child’s name.
• Gently applying stimuli such as holding the head & shaking the arm.
• Observe if the child makes some or opens their eyes to the rescuer’s voice or touch.
• If a child is unresponsive, immediately call for help & look for breathing (gasping, absence of chest movement), and check a pulse.
• If there is no breathing or only gasping or no pulse within 10 seconds, start CPR.

Step 2: Airway assessment & management

• Can a child talk? Is the airway open?
• LOOK for signs of airway obstruction and chest & abdominal movement. If there is a presence of secretions, blood, and vomitus, do suction or clean the airway. If there is a foreign body visualized, remove it.
• LISTEN for noisy breathing (wheeze, snoring, stridor)
• FEEL for airflow from nose & mouth. (respiration)
• The basic technique for airway opening is the head tilt & chin lift technique.

Step 3: Breathing assessment & management

• LOOK for breathing, count respiration, increased breathing work, and cyanosis.
• LISTEN for air entry quality, types of breathing sound, wheeze & measure oxygen saturation.
• Maintain oxygenation & ventilation after securing airway patency.
• Maintain oxygen concentration by giving a high concentration of oxygen if available.
• Maintain oxygen saturation at 94-98%Maintain ventilation through mask & bag device.
• Select the correct size of the mask.
• Position the head slightly extended & apply the mask to the face. The narrow portion of the mask should be at the bridge of the nose.
• Squeeze the bag to give breaths (1 second each) while watching for the chest rise. 

Step 4: Circulatory assessment

• Evaluate heart rate & rhythm.
• Evaluate central pulse (femoral, brachial in infants)
• Check the capillary refill time by pressing on nail beds. Press on nail beds for 5 seconds & it should be bright red for 2-3 seconds in infants.
• Evaluate skin color in nail beds, palms & soles.
• Evaluate blood pressure, urine output & level of consciousness.

Step 5: Start CPR (cardiopulmonary resuscitation)

• If the heart rate is less than 60 seconds with signs of poor perfusion or if the heart rate is absent, immediately start CPR.
• CPR at the rate of 30:2 chest compression & ventilation.

Basic ways of giving CPR to an infants

1. Check for a pulse in the brachial artery.
2. Perform compressions using two fingers technique if one rescuer or with hands encircling technique by using two thumbs with hands encircling the infant’s chest (two rescuers).
3. Place your hand over the lower half of the sternum & carry out compression.
4. Compression depth should be 1/3 of the chest depth (4cm)

High-quality Cardiopulmonary Resuscitation (CPR)

• Adequate chest compression rate (100-120/min)
• Adequate chest compression depth (>1/3 depth of chest)
• Minimize interruption during CPR (Change rescuers every 2 minutes if possible)
• Allowing full recoil of the chest between compressions.
• Avoiding excessive ventilation.

Basic criteria for giving CPR to an infant.

Conclusions

Thus, we can conclude that cardiopulmonary resuscitation or CPR is a lifesaving technique performed in times of emergency to promote spontaneous circulation & breathing in case of cardiac arrest.

Every child caretaker should be aware of the five essential steps of infant cardiopulmonary resuscitation. A child caretaker should be well knowledgeable about these basic steps. A single rescuer can support the vital respiration & circulatory functions of a collapsed child with no equipment by applying the basic techniques.

The main aim of the 5 essential steps of cardiopulmonary resuscitation is to restore respiratory & cardiac functions.