Cardiac arrest in infants under 12 months is a rare but critical emergency, most often caused by respiratory failure rather than cardiac disease. Unlike adults, where cardiac causes dominate, infants typically progress from airway obstruction, apnea, or respiratory distress into hypoxia and cardiac arrest.
Immediate and correct cardiopulmonary resuscitation (CPR) dramatically improves survival outcomes. For this reason, medical students, nursing professionals, and healthcare providers must master infant-specific CPR techniques, which differ from those used in older children and adults.
This guide provides a step-by-step explanation of pediatric CPR (<12 months), incorporating vital signs, compression techniques, and resuscitation ratios.
Pediatric Vital Signs by Age
Knowing normal vital signs is crucial when determining arrest or compromise.
| Age Group | Respirations (breaths/min) | Pulse (beats/min) | Systolic BP (mmHg) |
|---|---|---|---|
| Newborn | 30–50 | 120–160 | 60–80 |
| 6 mo – 1 yr | 30–40 | 120–140 | 70–80 |
| 2–4 yr | 20–30 | 100–110 | 80–95 |
| 5–8 yr | 14–20 | 90–100 | 90–100 |
| 8–12 yr | 12–20 | 80–100 | 100–110 |
| >12 yr | 12–20 | 60–90 | 100–120 |
For infants, a pulse <60 beats/min with poor perfusion is considered a strong indicator to begin CPR.
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Order of Events in Infant CPR (<12 Months)
Step 1: Pulse Check
- Check the pulse for no longer than 10 seconds.
- Infants (<1 year): Check brachial pulse (inside of the upper arm).
- Children (>1 year): Check carotid pulse.
If no pulse or a pulse <60/min with signs of poor perfusion, start chest compressions immediately.
Step 2: Call for Help
- Activate the emergency response system.
- Shout for nearby help.
- Delegate someone to call 911 or local emergency number and to retrieve an AED (Automated External Defibrillator).
If alone with no phone, perform 2 minutes of CPR before leaving to get help or an AED.
Step 3: Chest Compressions
- Begin CPR with chest compressions.
- Perform 2 minutes of CPR before AED retrieval if alone.
Compression Details:
Rate: 100–120 compressions per minute.Depth:
- Infants: One-third of the chest’s anterior–posterior diameter (~1.5 inches or 4 cm).
- Children: 2 inches (~5 cm).
Technique:
- Single rescuer: Two fingers on the sternum (just below nipple line).
- Two rescuers: Two thumbs encircling hands technique for better pressure and control.
Compression-to-Breath Ratios:
- Single rescuer: 30 compressions : 2 breaths (30:2).
- Two rescuers: 15 compressions : 2 breaths (15:2).
Step 4: Continue CPR Until Help Arrives
Continue compressions and breaths until:
- Emergency responders arrive.
- An AED becomes available.
- The infant shows signs of life (movement, breathing, pulse).
If using an AED, apply pediatric pads (or adult pads if unavailable, placed anteroposteriorly).
Compression Techniques in Infants
1. Two-Finger Technique (Single Rescuer):
- Place two fingers just below the nipple line on the sternum.
- Ideal for quick response when alone.
- Rescuers encircle the infant’s chest with hands.
- Use thumbs for compressions on sternum.
- Provides superior compression depth and consistency.
Why Infant CPR Differs from Adult CPR
- Infants have smaller chest cavities, requiring careful control of depth.
- The primary cause of arrest is respiratory failure, not cardiac arrhythmia.
- Pulse checks differ: brachial artery (infants) vs. carotid artery (children/adults).
- Compression ratios differ depending on number of rescuers.
- Risk of over-compression and rib fractures is higher due to fragile bones.
Clinical Tips and Key Takeaways
- Always start with airway and breathing assessment, since hypoxia is the leading cause of cardiac arrest in infants.
- Avoid over-ventilation; deliver gentle breaths just enough to cause chest rise.
- Use infant AED pads when available, or adult pads placed front and back if necessary.
- Prioritize quality compressions: adequate depth, full recoil, and correct rate.
- Minimize interruptions to compressions—resume immediately after breaths or AED shocks.
Frequently Asked Questions (FAQ)
Q1. What is the most common cause of cardiac arrest in infants?
Respiratory failure, often due to airway obstruction, apnea, infections, or suffocation.
Q2. What is the preferred pulse check site in infants?
The brachial artery inside the upper arm.
Q3. What depth should infant chest compressions reach?
Approximately one-third of the chest’s anterior–posterior diameter (~1.5 inches or 4 cm).
Q4. What is the compression-to-breath ratio for infant CPR?
- Single rescuer: 30:2
- Two rescuers: 15:2
Q5. When should CPR be stopped?
When the infant shows signs of life, professional help arrives, or an AED advises otherwise.
