BLS for Infants (0 to 12 months)

When it comes to infant CPR, it's essential to know the basics of BLS or Basic Life Support. BLS is the foundation of all lifesaving measures and is critical in emergency situations, including cardiac arrests, respiratory distress, or choking. Knowing how to perform Basic Life Support for infants can mean the difference between life and death.

What are the differences between Child and Infant BLS?

Basic Life Support for infants and children shares many similarities, but there are some notable differences to remember. Here are the key distinctions:

• To check the pulse of an infant, locate the brachial artery in the upper arm between the elbow and shoulder.
• During Cardiopulmonary Resuscitation, if there is only one rescuer, chest compressions on an infant should be performed using two fingers. If there are two rescuers and the rescuer's hands are large enough to encircle the infant's chest, two thumb-encircling hands can be used.
• The recommended chest compression depth for infants is around 1.5 inches deep, which is approximately one third of their chest depth.
• If you are single rescuer and encounter an unresponsive infant, it is recommended to administer CPR for two minutes prior to contacting 911 or retrieving an AED.
• Cardiac events are uncommon in infants, and cardiac arrest is typically preceded by respiratory problems. Early intervention for respiratory issues can improve survival rates. Prevention is the first step in the Pediatric Chain of Survival.
• If you witness an infant experiencing cardiac arrest, call 911 or the emergency medical system as you would in BLS for adults or children.
• Manual defibrillators are the preferred option for infants. If a manual defibrillator is unavailable, an AED with a pediatric attenuator is the next recommended alternative.

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What are the common causes of cardiac arrest in infants, and how can they be prevented?

Common causes of cardiac arrest in infants include choking, respiratory distress, or trauma. Choking occurs when an object obstructs the airway and prevents the infant from breathing. Respiratory distress is caused by a condition that affects the lungs and prevents normal breathing, such as pneumonia or asthma. Trauma can cause cardiopulmonary arrest if a physical injury leads to severe shock or blood loss.

To prevent cardiopulmonary arrest in infants, parents and caregivers should be aware of common hazards, such as small objects that could be choking hazards or heavy blankets that could obstruct breathing. Parents should also pay attention to signs of respiratory distress, such as rapid or labored breathing, a bluish tint around the mouth or nose, and coughing. If an infant shows any signs of distress, it's important to seek medical attention immediately.

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What are the steps for performing one-rescuer BLS on an infant?

If you find yourself alone with an unresponsive infant, follow these steps for a single rescuer:

1. Make sure the area is safe before approaching the patient
2. Tap the baby's foot and speak loudly to check if they respond.
3. If the infant does not respond, call 911/EMS and retrieve an AED. If possible, use a cell phone with a built-in speakerphone to make the call while remaining on the scene.
4. Check for normal breathing and simultaneously feel for the infant's brachial pulse for 5-10 seconds. If the infant doesn't have normal breathing or is only gasping, call for help.
5. When a pulse cannot be felt or is uncertain, initiate Cardiopulmonary Resuscitation by administering 30 chest compressions followed by two breaths. If the pulse is less than 60 beats per minute, CPR should also be initiated. To perform CPR:

• Place the infant face-up on a firm, flat surface.
• When performing chest compressions on an infant, it's important to use two fingers and avoid the end of the sternum to prevent injury.
• To achieve high quality chest compression, you must give a compression depth of approximately 1.5 inches at a rate of 100-120 compressions per minute.
• Push hard and fast.
• Allow for full chest recoil.
• Only allow minimal interruptions to the chest compressions.
• If help has not yet arrived, call 911 or the emergency medical staff and retrieve the AED.

5. Follow the prompts provided by the Automated External Defibrillator if available while continuing CPR until medical help arrives or until the infant's condition improves.
6. If the shock is indicated: Ensure no one touches the patient by shouting, "Clear, I'm Clear, you're Clear!" before delivering a shock.
7. If the shock is not indicated: Administer CPR for 2 minutes and recheck the rhythm every 2 minutes. Then, continue CPR until Advanced Life Support is available.
8. To put an infant in a recovery position, cradle the infant with the head tilted downward and slightly to the side to avoid aspiration.
9. Continually check the infant's breathing, pulse, and temperature.

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What are the steps for performing two-rescuer BLS on an infant?

If there is another rescuer with you at the scene, follow these steps:

1. To check if an infant is responsive, tap the bottom of their foot and speak loudly.
2. If the infant does not respond, have the second rescuer call 911 or the emergency medical staff and get an AED. (Note: most cell phones have built-in speakerphones, so you can call while remaining with the infant.)
3. Assess if the infant is breathing while checking for the brachial pulse for 5 to 10 seconds.
4. If you cannot feel a pulse or if you are unsure if there's a pulse, begin CPR by performing 15 compressions followed by two rescue breaths. If you can feel a pulse, but the rate is less than 60 beats per minute, begin CPR.
5. Perform CPR with a sequence of 15 chest compressions by one rescuer, followed by two rescue breaths administered by the second rescuer. Switch place every 2 minutes.
6. It is recommended to give chest compression using the two-thumb method. Care should be taken to avoid applying pressure to the bottom of the sternum, as this may cause harm to the infant.
7. Compression depth should be approximately 1.5 inches deep and at a rate of 100-120 compressions per minute.
8. It is recommended to follow AED prompts if available and continue administering CPR until emergency medical services arrive or until the infant's condition shows signs of improvement.
9. To put an infant in a recovery position, cradle the infant with the head tilted downward and slightly to the side to avoid aspiration.
10. Continually check the infant's breathing, pulse, and temperature.

What are the survival rates for infants who receive prompt BLS intervention?

Prompt Basic Life Support intervention for infants can greatly increase the chance of survival. Studies have shown that infants who receive prompt BLS intervention have an increased chance of survival, and the earlier in life that the infant receives help, the greater the chance of survival. When Cardiopulmonary Resuscitation is started within minutes of an infant's cardiac arrest, the chances of successful resuscitation range from 60-80%. If performed within 15 minutes, the survival rate is 30-50%. Early intervention is critical for infants in cardiac arrest, as their chance of survival decreases significantly with each passing minute.

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