First Responder EMS Curriculum for Training Centers in Eurasia

Coordination of Compressions and Rescue BreathingExternal chest compressions for infants and children should always be accompanied by rescuebreathing. In the infant and child, a compression-ventilation ratio of 5:1 is maintained for both 1and 2 rescuers. The 2-rescuer technique should be taught to healthcare providers. For infants inthe special resuscitation circumstances of the delivery room and neonatal intensive care setting,even more emphasis is placed on ventilation during resuscitation, and a 3:1 compressionventilationratio is recommended (see "Part 11: Neonatal Resuscitation").When 2 rescuers are providing CPR for an infant or child with an unsecured airway, the rescuerproviding the compressions should pause after every fifth compression to allow the secondrescuer to provide 1 effective ventilation. This pause is necessary until the airway is secure(intubated). Once the airway is secure (the trachea is intubated), the pause is no longer necessary.However, coordination of compressions and ventilation may facilitate adequate ventilation evenafter tracheal intubation and is emphasized in the newly born (see "Part 11: NeonatalResuscitation"). Compressions may be initiated after chest inflation and may augment activeexhalation during CPR. Although the technique of simultaneous compression and ventilationmay augment coronary perfusion pressure in some settings, it may produce barotrauma anddecrease ventilation and is not recommended. Priority is given to assuring adequate ventilationand avoidance of potentially harmful excessive barotrauma in children.Reassess the victim after 20 cycles of compressions and ventilations (slightly longer than 1minute) and every few minutes thereafter for any sign of resumption of spontaneous breathing orsigns of circulation. The number 20 is easy to remember, so it is used to provide a guidelineinterval for reassessment rather than an indication of the absolute number of cycles delivered inexactly 1 minute. In the delivery room setting, more frequent assessments of heart rateapproximatelyevery 30 seconds-are recommended for the newly born (see "Part 11: NeonatalResuscitation").In infants, coordination of rapid compressions and ventilations by a single rescuer in a 5:1 ratiomay be difficult. To minimize delays, if no trauma is present, the rescuer can maintain airwaypatency during compressions by using the hand that is not performing compressions to maintaina head tilt. Effective chest expansion should be visible with each breath you provide. If the chestdoes not rise, use the hand performing chest compressions to perform a chin lift (or jaw thrust) toopen the airway when rescue breaths are delivered. Then return the hand to the sternumcompression position to resume compressions after the breath is delivered. If trauma is present,the hand that is not performing compressions should maintain head stability during chestcompressions.In children, head tilt alone is often inadequate to maintain airway patency. Often both hands areneeded to perform the head tilt-chin lift maneuver (or jaw thrust) with each ventilation. The timeneeded to position the hands for each breath, locate landmarks, and reposition the hand toperform compressions may reduce the total number of compressions provided in a minute.Therefore, when moving the hand performing the compressions back to the sternum, visualizeand return your hand to the approximate location used for the previous sequence ofcompressions.Compression-Ventilation RatioIdeal compression-ventilation ratios for infants and children are unknown. From an educationalstandpoint, a single universal compression-ventilation ratio for victims of all ages and all368 First Responder EMS Curriculum/AIHA, July 2002