From the Guidelines
For pediatric cardiac arrest, use a 15:2 compression to ventilation ratio when providing CPR with two rescuers, and use a 30:2 ratio when performing single-rescuer CPR, while the 3:1 ratio is specifically reserved for neonatal resuscitation (newborns up to approximately 4 weeks of age) as emphasized by the most recent guidelines 1. This distinction is crucial because children have different physiological needs than neonates. Key points to consider when deciding on the compression to ventilation ratio include:
- Neonates require more frequent ventilation due to their primarily respiratory causes of arrest, hence the 3:1 ratio which emphasizes oxygenation 1.
- For children beyond the neonatal period, cardiac causes become more common, so the 15:2 ratio (with two rescuers) or 30:2 ratio (with one rescuer) provides an appropriate balance between circulation and ventilation 1. When performing CPR on a pediatric patient, it is essential to:
- Deliver compressions at a rate of 100-120 per minute with a depth of approximately one-third the anterior-posterior diameter of the chest.
- Ensure complete chest recoil between compressions and minimize interruptions to maintain effective circulation. The choice between the 3:1 and 15:2 ratios should be guided by the patient's age and the likely cause of the cardiac arrest, with the 3:1 ratio being preferred for neonates and the 15:2 ratio for older children, as supported by the guidelines 1.
From the Research
Compression to Ventilation Ratio in Pediatric Cardiac Arrest
The American Heart Association and other international guidelines recommend different compression to ventilation (C:V) ratios for pediatric cardiac arrest, depending on the age of the patient and the rescuer's level of training.
- For newborns (0-28 days), a 3:1 C:V ratio is recommended 2.
- For infants (29 days to 12 months) and children (1-8 years), a 15:2 or 30:2 C:V ratio is recommended, but the 15:2 ratio is more commonly used in practice 3, 4.
- For children (1-12 years) and adolescents (13-18 years), a 15:2 or 30:2 C:V ratio is also recommended, with the 15:2 ratio being more commonly used 3, 4.
Factors Influencing C:V Ratio
Several factors can influence the choice of C:V ratio, including:
- The patient's age and size
- The rescuer's level of training and experience
- The availability of advanced life support equipment, such as ventilators and oxygen therapy
- The underlying cause of the cardiac arrest
Evidence-Based Recommendations
Studies have shown that the 15:2 C:V ratio is effective in pediatric cardiac arrest, with no significant differences in outcomes compared to the 30:2 ratio 4.
- A study published in the Journal of the American College of Cardiology found that rescue-breathing CPR (RB-CPR) was associated with improved neurologically favorable survival compared to compression-only CPR (CO-CPR) in pediatric out-of-hospital cardiac arrest 5.
- The European Resuscitation Council (ERC) 2021 guidelines recommend a 15:2 C:V ratio for pediatric basic life support, with a target saturation of 94-98% during oxygen therapy and a fluid bolus of 10 ml/kg 3.