To whom and how should external cardiac compression be delivered?
Apply external cardiac compression to any child with ineffective pulses. A compressions-to-ventilations ratio of 30:2 is recommended for the lone rescuer performing CPR in infants and children. If two rescuers are performing CPR, a compressions-to-ventilations ratio of 15:2 is recommended. When a tracheal tube is placed, compressions should not be interrupted for ventilations.
It takes a number of compressions to raise coronary perfusion pressure, which drops with each pulse. Interruptions in chest compressions are associated with a decreased rate of return of spontaneous circulation. It is currently recommended that in infants, compressions be applied evenly over the lower half of the sternum. Deliver chest compressions at a rate of 100 per minute: “push fast” and “push hard.” The two thumb–encircling hands technique may be preferred for two-rescuer CPR because it produces higher coronary perfusion pressure and more consistently results in appropriate depth of compression. But either a one- or two-hand technique can be used to perform chest compressions in children. For children and adolescents, compress the lower half of the sternum with the heel of one hand or with two hands, but do not press over the xiphoid process or ribs.
American Heart Association: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 13: Pediatric Basic Life Support. Circulation 2010;122:S862-S875.