Chest compressions form the basis of BLS.
Please review adult compressions lesson before proceeding to this. Click here to review.
In the absence of a pocket mask in any age group, if you are not comfortable giving mouth to mouth ventilations, AHA advises you to proceed with compression only CPR. This reinforces the fact that compressions should be a priority in CPR and minimizing interruptions is a quality indicator.
The ratio of compressions to breaths is 30:2 in pediatric and adult population when there is a single rescuer. When there are more than one rescuer, you must switch to 15:2 ratio, giving more ventilations.
Compressions in a child
In children, the technique to compress the chest is similar to adults.
The victim should be on a flat firm surface. Place yourself next to the victim on a side. If the victim is on the floor, you should kneel down (on your knees). If the victim is on a height (stretcher / bed), you may stand. Place the heel of your hand in the center of chest at the level of nipples (lower half of sternum / breast bone). Interlock your fingers as shown in picture and start pushing the chest downwards. Your wrists, elbows and shoulders should be in one plane, at 90 degrees to the floor. If you don’t maintain that 90 degree posture, you will have to use more force to achieve compression depth and that means you will get tired easily. You should not bend your elbows during compressions.
If the child is lean built, using just one hand to achieve the depth is acceptable as shown in picture.
In case of infants, use two finger technique as shown to compress chest when you are a single rescuer.
But if you have two or more rescuers during infant CPR, you may switch to thumb encircling technique by placing two hands on either side of chest while two thumbs meet at sternum and other fingers go behind the chest.
High quality – hard and fast chest compressions have following charecteristics:
- Rate 100-120 /minute
- Depth 1/3rd the chest diameter ( roughly 2 inches or 5 centimeters )
- Allow complete chest recoil
- Minimize interruptions
A rate of 100-120 compressions per minute is advised. If you go at a rapid rate, heart chambers will not have time to refill with blood, rendering your CPR ineffective. If you go too slow, you might not be pumping blood adequately and organs will not be perfused well. You can search for METRONOME online and use it as a guide to maintain a good rate during resuscitation. It gives a beep sound at a set rate (we advice setting a rate of 100 or 110). Please try that now, to get used to it. Click here to try.
Adequate depth is needed to effectively pump the blood out of heart to mimic heart function.
For an averagely built victim, a depth of at least 1.5 inches or 4cms is indicated.
But this doesn’t work for an obese person. So look to go for a depth of 1/3rd of the chest antero-posterior diameter, which works for all individuals. If a question gives options with inches, cms, and depth fraction (1/3rd), it’s wiser to choose depth fraction. If you compress too deep, there’s a chance that you might injure the internal organs.
Allow chest recoil
Chest recoil is allowing the chest to come back to it’s natural place after giving a compression. With each compression, the pressure inside the chest will increase and that will stop the blood from entering in to the chest (heart refill is inhibited) from jugular veins and venacava. So it is important that you allow adequate chest recoil to allow the heart to refill with blood which will be pumped out with next compression.