BLS (Basic life support) / CPR for Infants

Introduction: As a home nurse in dubai who will be looking after babies, infants and elderly, we should be very well informed about how to do the Basic life support or CPR (Cardiopulmonary resuscitation). This blog covers the basic steps of CPR when you do babysitting or taking care of infants.

BLS (Basic life support) for infants:

For the purposes of the BLS sequence described in the Pediatric BLS Algorithm (Figure 1 below), the term infant means infants to 1 year of age (12 months), excluding newly born infants in the delivery room. For BLS for children 1 year and older, see the other blog.

Note: these are to be performed by healthcare providers and not by lay rescuers

The infant BLS sequence and skills are very similar to those used for child and adult CPR.
The key differences for infant BLS are

• The location of pulse check: brachial artery in infants
• Technique of delivering compressions: 2 fingers for single rescuer and 2 thumb – encircling hands technique for 2 rescuers
• Compression depth: at least one third the chest depth, approximately 4 cm (1 1/2 inches)
• Compression-ventilation rate and ratio for 2 rescuers: same as for child – 15:2 ratio for 2 rescuers
• When to activate the emergency response system:
  • if you did not witness the arrest and are alone, provide 2 minutes of CPR before leaving the infant to activate the emergency response system and get the AED (or defibrillator).
  • if the arrest is sudden and witnessed, leave the infant to activate the emergency response system and get the AED (or defibrillator), then return to the infant.

Locating the Brachiai Artery Pulse:

To perform a pulse check in an infant, palpate a brachial pulse. It can be difficult for healthcare providers to determine the presence or absence of a pulse in any victim, but it can be particularly difficult in an infant.
If an infant is unresponsive and not breathing or only gasping and you do not definitely feel a pulse within 10 seconds, start CPR. it is important that you begin chest compressions if you do not definitely feel a pulse within 10 seconds.

Follow these steps to locate the brachial artery pulse:

1. Place 2 or 3 fingers on the inside of the upper arm, between the infant’s elbow and shoulder.
2. Press the index and middle fingers gently on the inside of the upper arm for at least 5 but no more than 10 seconds when attempting to feel the pulse

Compression depths in infants:

In infants, the recommended compression depth is at least one third of the anterior-posterior depth of the infant’s chest, or approximately 4 cm (1 1/2 inches). This is different from compression depth for both adults (at least:5 cm [2 inches]) and children (at least one third the depth of the chest, approximately 5 cm ([2 inches]).

Follow these steps to perform 1-rescuer BLS for an infant:

1. Check the infant for a response and check breathing. If there is no response and no breathing or only gasping, shout for help.
2. If someone responds, send that person to activate the emergency response system and get the AED (or defibrillator).
3. Check the infant’s brachial pulse (take at least 5 but no more than10 seconds).
4. if there is no pulse or if, despite adequate oxygenation and ventilation, the heart rate is <60/min with signs of poor perfusion, perform cycles of compressions and breaths (30:2 ratio), starting with compressions.
5. After 5 cycles, if someone has not already done so, activate the emergency response system and get the AED (or defibrillator).

Follow these steps to give chest compressions to an infant using the 2-finger technique:

1. Place the infant on a firm, flat surface.
2. Place 2 fingers in the center of the infant’s chest just below the nipple line. Do not press on the bottom of the breastbone (Figure 2).
3. Push hard and fast. To give chest compressions, press the infant‘s breast bone down at least one third the depth of the chest (approximately 4 cm [1 1/2 inches]). Deliver compressions in a smooth fashion at a rate of at least 100/min.
4. At the end of each compression, make sure you allow the chest to recoil (re-expand} completely. Chest recoil allows blood to flow into the heart and is necessary to create blood flow during chest compressions. Incomplete chest recoil will reduce the blood flow created by chest compressions. Chest compression and chest recoil/relaxation times should be approximately equal.
5. Minimize interruptions in chest compressions.