Cardiopulmonary Resuscitation (CPR) is a time-sensitive intervention that maintains blood flow and oxygenation when the heart stops. For children, the approach differs significantly from adults because pediatric cardiac arrest is frequently related to respiratory failure rather than a sudden heart rhythm issue. When two trained rescuers are present, the protocol changes to optimize the delivery of both compressions and ventilations. This specialized method provides the highest quality of care possible before emergency medical services arrive.
Defining the Child and Two-Rescuer Scenario
The protocols for child CPR apply to individuals from one year of age up to the onset of puberty. Puberty is generally recognized by the presence of secondary sex characteristics, such as breast development in females or axillary hair in males. This age distinction is important because a child’s smaller, more flexible body requires different physical techniques and force compared to an adult.
The two-rescuer scenario involves two trained individuals who coordinate their efforts to deliver CPR simultaneously. The presence of a second rescuer significantly improves the efficiency of resuscitation by allowing one person to focus on chest compressions while the other manages rescue breaths. This team approach minimizes interruptions in blood circulation and reduces rescuer fatigue. The coordinated effort maintains the quality and consistency of care and allows for an adjustment to the compression-to-ventilation ratio.
The Critical Compression-to-Ventilation Ratio
The standard protocol for two-rescuer child CPR is a compression-to-ventilation ratio of 15:2. This means rescuers deliver 15 chest compressions followed immediately by 2 rescue breaths, repeating the cycle continuously. This ratio is a departure from the 30:2 ratio used in single-rescuer child CPR and all adult CPR scenarios.
The higher frequency of ventilations in the 15:2 ratio is a direct response to the most common cause of cardiac arrest in children. Pediatric arrests are more frequently the result of severe respiratory distress or shock, leading to a lack of oxygen, unlike adults where a sudden cardiac event is often the primary cause. The child’s body is often depleted of oxygen, making delivery a higher priority. This increased ventilation rate helps replenish critically low oxygen levels in the blood, which is necessary to preserve brain function. The two-rescuer setup allows for this aggressive ventilation strategy without sacrificing the rate or quality of chest compressions.
Mechanics of Delivering Compressions and Ventilations
For compressions to be effective, the rescuer must push hard and fast, aiming for a rate between 100 and 120 compressions per minute. The depth of each compression should be approximately one-third the anterior-posterior depth of the child’s chest, translating to about two inches (five centimeters). Proper depth is necessary to effectively circulate blood.
The compressor may use one or two hands, depending on the size of the child, focusing on achieving the correct depth and rate. The second rescuer, often positioned at the child’s head, manages the airway and delivers the ventilations. The two rescue breaths must be delivered quickly, with each breath lasting about one second. Visible chest rise confirms successful ventilation, and the pause for breaths should not last longer than ten seconds. To maintain high-quality compressions and prevent fatigue, the two rescuers should switch roles approximately every two minutes. This designated switch allows the compressor to rest and ensures effective blood flow continues with minimal interruption.