External Cardiac Compression

The brachial pulse is recommended for monitoring purposes for infants younger than age 1. Above this age, the femoral pulse is most easily accessible, but most guidelines recommend assessment of the carotid pulse by laypersons. Absence of pulse, or poor perfusion with a heart rate of 60 bpm or less, mandates external cardiac compression. Most patients should be placed on a hard surface. With smaller infants, the wraparound two-thumb technique can be used.

Current standards advocate compressions over the lower sternum as opposed to midsternum.5 Whether to use two fingers, two thumbs, three fingers, or the heel of the hand depends on the size of the child. Whichever method comfortably produces a compression depth of approximately one-third the anteroposterior diameter should be used. The rate of compressions is at least 100/min in infants and older children. The ratio of ventilations to compressions is 1:5 for both one-person CPR and two-person CPR. A pause of 1 to 1.5 s between ventilations should be allowed for adequate exhalation. To assess the adequacy of the compression depth and rate, the femoral or carotid artery should be palpated during compressions.

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