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A child or infant is in respiratory arrest if they are not breathing and have a central pulse. They
are in respiratory failure if they have ineffective ventilation and a central pulse. Like an adult, a
pediatric patient in respiratory failure may have some ventilation; however, this ventilation is
insufficient to sustain needed gas exchange, oxygen and carbon dioxide.
To provide care to a child or infant in respiratory arrest or respiratory failure, follow these
steps. If you have not already done so, activate EMS, the rapid response team or the
resuscitation team, as appropriate, and call for an AED.
Deliver ventilations; each ventilation should last about 1 second and make the chest begin to
rise.
Child pulse >60 BPM not breathing with central pulse (respiratory failure) If their central
pulse is > 60 bpm, deliver 1 ventilation every 2 to 3 seconds. If an advanced airway is in place,
the rate remains the same. If at any time central pulse decreases to ≤ 60 bpm with poor
perfusion despite adequate ventilations and oxygen, start CPR.
Child pulse ≤60 BPM not breathing with central pulse (respiratory failure) If their central
pulse is ≤ 60 bpm with signs of poor perfusion, start CPR. If at any time central pulse and
perfusion improve, stop CPR and deliver 1 ventilation every 2 to 3 seconds until the patient is
ventilating sufficiently.
Child not breathing with central pulse (respiratory failure) Perform a primary assessment
(Airway, Breathing, Circulation, Disability, Exposure).
Continue to check breathing and pulse every 2 minutes.If at any time central pulse becomes
absent, start CPR immediately and use an AED when it is available.
Position patient as appropriate for clinical condition.
Perform secondary assessment as patient condition allows.
Reassess the patient, recognize issues and provide care as needed.
,Pediatric Out-of-Hospital
Cardiac Chain of Survival 1. Prevention
Community prevention is key. As the most common causes of cardiac arrest in children and
infants include respiratory emergencies, shock and preventable injury (e.g., trauma, drowning,
choking or electrocution), efforts to reduce these events and manage them are key. In addition,
establishing systems to respond, such as CPR education, public awareness of what to do in an
emergency and telecommunicator CPR is important.
2. Recognition of Cardiac Emergency and Activation of Emergency Response System
Immediate recognition of cardiac arrest and activation of EMS quickly gives the patient access
to necessary personnel, equipment and interventions as soon as possible after arrest.
3. Early High-Quality CPR
High-quality CPR should be initiated immediately after recognizing cardiac arrest.
4. Pediatric Advanced Life Support
Effective, pediatric advanced life support gives the patient access to care delivered by specially
trained professionals.
5. Integrated Post-Cardiac Arrest Care
After return of spontaneous circulation (ROSC), survival outcomes are improved when
providers work to stabilize the patient, minimize complications, and diagnose and treat the
underlying cause.
6. Recovery
A sixth link has been added to highlight the importance of recovery including continued follow-
up during the recovery process in the form of rehabilitation, therapy and support from family
and healthcare providers.
, CPR for children 1. firm flat surface
2. bed at appropriate working height
3. Expose chest, place heel of hand on center of chest on lower part of sternum interlace other
hand
4. Shoulders directly over hands keep arms straight and lock elbows
5. Compress to a depth of approx. 2"
6. 100-120 compressions
One provider: 30 compressions to 2 ventilations
Multiple providers: 15:2 & BVM for ventilations
Switch positions every 2 minutes
If child shows signs of life stop CPR monitor airway breathing and pulse
CPR for Infants 1. Crib at appropriate working height
2. Obtain CPR board or use cpr ready crib/bed or stable surface such as table
3. Encircling thumbs technique place thumbs just below nipple line
4. Press down about 1 1/2 inches deep at rate of at least 100 but no more than 120 per minute
5. Allow for complete chest recoil
2 finger technique- two fingers of hand closest to infants feet center of chest just below nipple
line on sternum. press 1.5 inches deep at rate of at least 100 but no more than 120 bpm
A child or infant is in respiratory arrest if they are not breathing and have a central pulse. They
are in respiratory failure if they have ineffective ventilation and a central pulse. Like an adult, a
pediatric patient in respiratory failure may have some ventilation; however, this ventilation is
insufficient to sustain needed gas exchange, oxygen and carbon dioxide.
To provide care to a child or infant in respiratory arrest or respiratory failure, follow these
steps. If you have not already done so, activate EMS, the rapid response team or the
resuscitation team, as appropriate, and call for an AED.
Deliver ventilations; each ventilation should last about 1 second and make the chest begin to
rise.
Child pulse >60 BPM not breathing with central pulse (respiratory failure) If their central
pulse is > 60 bpm, deliver 1 ventilation every 2 to 3 seconds. If an advanced airway is in place,
the rate remains the same. If at any time central pulse decreases to ≤ 60 bpm with poor
perfusion despite adequate ventilations and oxygen, start CPR.
Child pulse ≤60 BPM not breathing with central pulse (respiratory failure) If their central
pulse is ≤ 60 bpm with signs of poor perfusion, start CPR. If at any time central pulse and
perfusion improve, stop CPR and deliver 1 ventilation every 2 to 3 seconds until the patient is
ventilating sufficiently.
Child not breathing with central pulse (respiratory failure) Perform a primary assessment
(Airway, Breathing, Circulation, Disability, Exposure).
Continue to check breathing and pulse every 2 minutes.If at any time central pulse becomes
absent, start CPR immediately and use an AED when it is available.
Position patient as appropriate for clinical condition.
Perform secondary assessment as patient condition allows.
Reassess the patient, recognize issues and provide care as needed.
,Pediatric Out-of-Hospital
Cardiac Chain of Survival 1. Prevention
Community prevention is key. As the most common causes of cardiac arrest in children and
infants include respiratory emergencies, shock and preventable injury (e.g., trauma, drowning,
choking or electrocution), efforts to reduce these events and manage them are key. In addition,
establishing systems to respond, such as CPR education, public awareness of what to do in an
emergency and telecommunicator CPR is important.
2. Recognition of Cardiac Emergency and Activation of Emergency Response System
Immediate recognition of cardiac arrest and activation of EMS quickly gives the patient access
to necessary personnel, equipment and interventions as soon as possible after arrest.
3. Early High-Quality CPR
High-quality CPR should be initiated immediately after recognizing cardiac arrest.
4. Pediatric Advanced Life Support
Effective, pediatric advanced life support gives the patient access to care delivered by specially
trained professionals.
5. Integrated Post-Cardiac Arrest Care
After return of spontaneous circulation (ROSC), survival outcomes are improved when
providers work to stabilize the patient, minimize complications, and diagnose and treat the
underlying cause.
6. Recovery
A sixth link has been added to highlight the importance of recovery including continued follow-
up during the recovery process in the form of rehabilitation, therapy and support from family
and healthcare providers.
, CPR for children 1. firm flat surface
2. bed at appropriate working height
3. Expose chest, place heel of hand on center of chest on lower part of sternum interlace other
hand
4. Shoulders directly over hands keep arms straight and lock elbows
5. Compress to a depth of approx. 2"
6. 100-120 compressions
One provider: 30 compressions to 2 ventilations
Multiple providers: 15:2 & BVM for ventilations
Switch positions every 2 minutes
If child shows signs of life stop CPR monitor airway breathing and pulse
CPR for Infants 1. Crib at appropriate working height
2. Obtain CPR board or use cpr ready crib/bed or stable surface such as table
3. Encircling thumbs technique place thumbs just below nipple line
4. Press down about 1 1/2 inches deep at rate of at least 100 but no more than 120 per minute
5. Allow for complete chest recoil
2 finger technique- two fingers of hand closest to infants feet center of chest just below nipple
line on sternum. press 1.5 inches deep at rate of at least 100 but no more than 120 bpm
