From the Guidelines
For an unresponsive, non-breathing infant without a pulse and no available help, immediately begin CPR with chest compressions, as recommended by the 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. The first step is to verify scene safety, then check for responsiveness by shaking or pinching gently, and shout for help if the infant is unresponsive 1. Since the infant is unresponsive, not breathing, and does not have a pulse, and there is no one around to help, the next steps are crucial for survival.
- Start with 30 chest compressions at a rate of 100-120 compressions per minute, using two fingers for an infant, pressing down approximately 1.5 inches (4 cm) or about one-third the depth of the chest, as described in the Pediatric Basic Life Support Algorithm for Healthcare Providers—Single Rescuer 1.
- After 30 compressions, open the airway using a head-tilt chin-lift maneuver (being careful not to overextend the neck) and give 2 rescue breaths, each lasting about 1 second and just enough to make the chest rise, following the guidelines for infant CPR 1.
- Continue this 30:2 compression-to-ventilation ratio, which is the recommended sequence for healthcare providers and others trained in two-person CPR, with minimal interruptions in chest compressions 1.
- After about 2 minutes (or 5 cycles of 30:2), check for a pulse and breathing, and if still absent, resume CPR, as the goal is to maintain blood flow to vital organs until advanced medical help arrives 1. It is essential to note that high-quality CPR with minimal interruptions is crucial, as infants most commonly arrest due to respiratory issues that lead to cardiac arrest, making both effective compressions and ventilations essential for survival 1. If alone, perform CPR for 2 minutes before leaving to call emergency services, following the recommendations for initiation of CPR and the sequence of rescue actions tailored to the most likely cause of arrest 1.
From the Research
First Appropriate Actions for Unresponsive Infant
When responding to an infant who is unresponsive, not breathing, and does not have a pulse, with no available help, the first appropriate actions to take are:
- Check the infant's airway, breathing, and circulation (ABCs) 2
- Determine if the infant has a pulse by listening to the apical pulse, as this method is faster and more accurate than palpating the brachial pulse 2
- If the infant is pulseless, begin cardiopulmonary resuscitation (CPR) with a compression-to-ventilation ratio of 30:2 or compression-only CPR if unwilling or unable to give expired-air breathing 3
- Use an automated external defibrillator if available 3
Key Considerations
- The American Heart Association recommends a compression-to-ventilation ratio of 3:1 for newborns, but for infants (from birth to 12 months), a ratio of 15:2 or 30:2 may be used 4, 3
- The prevention and formation of citizens in basic cardiopulmonary resuscitation are the most effective measures to reduce the mortality of cardiorespiratory arrest in children 5
- Early resuscitation before the patient becomes pulseless, along with early recognition and intervention, are likely to improve outcomes 6