CPR for an infant: Chest compressions (two-finger and two-thumb encircling techniques)

Authors: Rednenko V.V.

Editor: Rednenko V.V.

Clinical situation:

You are at home. A frightened neighbor has come running to you for help. She said her 8-month-old son was playing with toys and suddenly began coughing and choking heavily. Arriving at her apartment, you found an infant  lying on the floor with no signs of life. The infant is not breathing. You have performed five rescue breaths and should perform chest compressions.

Equipment for the practical skill:

• protective medical gloves;
• СPR infant simulator.

The procedure for performing a practical skill

• Chest compressions in the infant begins after the five initial rescue breaths. The infant should lie face-up on a firm, flat surface.
• Position yourself at the side of the infant.
• Move any bulky clothing away from the chest
• If you are a single rescuer use a two-finger technique
  • Place two fingers of one hand on the breastbone right below the nipple line

• If there are two or more rescuers use a two-thumb encircling technique
  •  Place both thumbs flat side by side on the lower half of the sternum (as above) with the tips pointing towards the infant's head.

• • Spread both hands with the fingers together to encircle the lower part of the infant's rib cage. 
  • The fingers should support the infant's back.
• Push straight down approximately at least one third the anterior-posterior dimension of the infant's chest (4 cm) at a rate of 100 to 120 beats per minute.
• Let the chest recoil to its normal position after every compression
• After15 compressions, tilt the head, lift the chin, and give two effective breaths.
• Continue compressions and breaths in a ratio of 15:2.
• When performing CPR with an assistant by cycle, including chest compressions and rescue breath in a ratio of 15:2, as you give compressions, count to 15. You can count out loud or silently. If you count silently, then say the count 13, 14, 15 out loud to orient the assistant giving the breathing.
• Continue compressions so that the pause, including the rescue breath, is no more than 10 s.
• Do not interrupt CPR at any moment unless there are clear signs of circulation (movement, coughing) or when exhausted.