In this section, we're going to cover two-responder infant CPR for the healthcare professional using a bag valve mask. (If you don't have a bag valve mask, a simple mask with a one-way valve will suffice.)
Also, it's important to have the right size mask. But if you don't have an infant size mask, proceed using an adult size mask. To use the adult mask on an infant, turn the adult mask upside down, so the apex portion that is designed for the nose is now on the infant's chin.
Much of what was covered in the last section – Child CPR with Two Responders – will apply in this section – Infant CPR with Two Responders. The one difference being the method of compressions which will be explained below.
Pro Tip #1: One variation that should be used when doing compressions on an infant or baby when a second responder is present, is circumferential compressions. To perform circumferential compressions, wrap your fingers around the sides of the infant's chest, placing both thumbs over the compression point just below the nipple line. One of your thumbnails should be resting on the top of the other.
If for some reason you're not able to perform circumferential compressions, then revert back to the normal compression procedure for infants – using your fingers at an angle perpendicular to the chest, meaning your knuckles are directly above your fingers during compressions. Remember that little force will be required when performing compressions on an infant.
Pro Tip #2: The rate of compressions to rescue breaths during infant CPR is the same as with children – 15 compressions for every two rescue breaths.
How to Provide Care
After making sure the scene is safe, that your gloves are on, and that you have your rescue mask with a one-way valve (or bag valve mask when there are two responders), begin calling out to the victim to assess whether or not the infant is responsive.
Are you OK? Can you hear me? (With infants, shouting their name, if you know it, may help.)
If you don't get an initial response, place your hand on the infant's forehead and tap on the bottom of his or her feet. If you still do not get a response, proceed with the following steps.
- Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc.
- Continue to assess the victim's responsiveness and vital signs – signs of breathing normally, signs of a pulse, etc.
- Check for a pulse using the brachial artery, located on the inside of the arm between the bicep and tricep against the humerus bone. Use the flat parts of your index and middle fingers and press on that artery. Spend no more than 10 seconds looking for a pulse.
- If you've determined at this point that the victim is unresponsive, not breathing normally, and has no pulse, continue immediately with CPR.
Two-Responder CPR Technique for Infants
Responder one:
- Draw an imaginary line across the infant's nipples and place your thumbs on top of one another on the lower part of the center of the sternum to perform circumferential compressions.
- Stand or kneel directly over the patient's chest. As less pressure is needed when performing CPR on infants, use only your thumbs to supply the force for the chest compressions, and count as you perform them.
- Conduct compressions that go to a depth of 1/3 of the infant's chest cavity, which should be around 1.5 inches deep, and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second.
- Perform 15 chest compressions.
Responder two:
- Grab the bag valve rescue mask and seal it over the infant's face and nose.
- If available, place something firm under the infant's shoulders to lengthen the neck a little and create a neutral or slightly sniffing head position.
- When using the bag valve mask, remember not to push down on the mask, but rather, lift the mandible up into the mask – using the CE form to seal the mask – and incorporate the proper head-tilt, chin lift as you do. Also, remember that with infants, the head-tilt, chin lift is neutral or slightly sniffing.
- Compress the bag on the bag valve mask and wait for the chest to rise and fall before administering the next breath.
Responder one:
- Go right back into your 15 chest compressions.
Responder two:
- Go right back to delivering two rescue breaths.
Once you reach the two-minute mark, the responder performing chest compressions will call out switch, or the agreed upon word or phrase you'll be using to coordinate a switching of duties.
Responder two, after delivering two more rescue breaths, will hand the bag valve mask to responder one, walk around the patient and get into proper position, and begin performing chest compressions, while responder one prepares to administer rescue breaths using the bag valve mask.
- Continue to perform 15 chest compressions to two rescue breaths – while switching duties every two minutes – until help arrives, an AED arrives, or the victim is responding positively and breathing normally.
A Word About Considerations for Pediatric Patients
Cardiac emergencies in children and infants are usually secondary to respiratory problems and airway restrictions. While congenital heart conditions are possible, they aren't common. When cardiac arrest occurs in children and infants, it's usually caused by one of the following:
- Airway and breathing problems
- Traumatic injuries or incidents – drowning, electrocution, poisoning, etc.
- A hard blow to the chest
- Congenital heart disease
- Sudden infant death syndrome (SIDS)