CPR Ratio for Adults, Children, and Infants

The CPR Ratio refers to the specific sequence of chest compressions and rescue breaths administered during cardiopulmonary resuscitation. It guides responders on the number of chest compressions to perform and how many rescue breaths to give to an individual experiencing cardiac arrest or a sudden cessation of breathing.

‍

Adults and Child CPR Ratio: CPR ratio for adults and older children is 30:2 for a single rescuer. You must perform 30 chest compressions followed by 2 rescue breaths and maintain a steady rhythm.

‍

Infant CPR Ratio: The CPR ratio is 30:2 for a single rescuer, the same as the ratio for adult/child.

‍

If there are two rescuers, the CPR ratio for the child and infant will be 15:2. You need to perform 15 chest compressions followed by 2 rescue breaths.

CPR Ratios for Adults

High-quality CPR has critical steps to follow, and there are certain metrics by the American Heart Association that must be followed to improve the survival rate from out-of-hospital cardiac arrest. This includes providing chest compressions at the proper rate and depth. Here is the CPR ratio that you must remember when performing CPR for an average adult.

Compression to Ventilation Ratio

Compression to Ventilation Ratio refers to the number of external chest compression given, followed by the number of ventilation breaths given while performing CPR. According to the American Heart Association, the correct compression to ventilation ratio for adults is 30:2. It means to provide 30 chest compressions after 2 rescue breaths and maintain a steady rhythm. If there is another lay rescuer, the same method must be followed, except that each person take turns performing the ventilation breaths and the compressions without pausing either.

American Heart Association guidelines also indicate that in patients with an advanced airway, one ventilation breath every six seconds should be given without interruptions in chest compression.

‍

Rate of Compressions

For adults, the CPR compression rate is 100-120 compressions per minute. Chest compression rate refers to the speed or rate of chest compression per minute during CPR. For example, a cardiac compression rate of 100 per minute means you give 100 compressions in 1 minute if there's no need for you to stop to provide ventilation. Usually, a lone rescuer performing 100/1 continuous compression will perform about 75 external chest compression per minute due to the need for ventilation breathing. You will only do chest compressions without stopping until emergency medical personnel takes over if the victim is intubated. In addition, you should minimize any interruptions to achieve a chest compression fraction of 60.

‍

Depth of Compressions

The compression depth for adults is at least 2- 2.4 inches deep or 5 to 6 cm, with a rate of 100-120 compressions per minute. Compression depth is how far down the victim's chest is compressed with each chest compression. It's also important to allow complete chest recoil between each compression.

‍

Rescue Breathing

Rescue breathing is the number of ventilation breaths that are given each minute. The ventilation rate for adults should be 10-12 breaths per minute. Each rescue breath should be given over 1 second with a sufficient tidal volume to produce chest rise. This is for victims who still have a pulse but don't have normal breathing.

If bag valve mask is used to provide ventilations, the correct volume of air to deliver during bvm ventilations is 500ml. For each breath, steadily and smoothly squeeze the bag to deliver a tidal volume of 6 to 7 mL/kg (or about 500 mL for an average size adult) over 1 second. The certified lay rescuers supply enough oxygen to preserve life by rescue breathing into the victim's lungs. It's important to act quickly because brain damage occurs after only 3 minutes without oxygen. Avoid excessive ventilation.

In a previous study of adults with out-of-hospital cardiac arrest, continuous chest compressions without rescue breathing did not result in significantly higher rates of survival than 30 compressions to 2 ventilations.

If an Automated External Defibrillator or AED is available, alternate 3-4 shocks with a minute of CPR. CPR should be continued until the emergency response is available or you see the patient's normal breathing or any signs of life.

‍

CPR Ratios for Children

Adults usually require CPR due to sudden cardiac arrest resulting from a heart attack, while children tend to require CPR due to respiratory issue that leads to cardiac arrest. It's essential that you know the proper CPR procedure, CPR child hand placement, and CPR ratio for children to be prepared when an emergency occurs.

Compression to Ventilation Ratio

According to the American Heart Association guidelines, the child compression to ventilation ratio for a single rescuer is 30:2, which is the same for adults. This means that single rescuers need to perform 30 chest compressions followed by two rescue breaths. If there are two rescuers, the ratio of compressions will be 15:2.

If you are an untrained bystander, you should perform hands-only CPR or chest compressions only without rescue breathing until the emergency response is available to take over. 

‍

Rate of Compressions

The recommended number of compressions per minute for children is at least 100 to 120 beats per minute. After 30 compressions, tilt the head, lift the chin, and give two effective breaths. Although the rate of CPR compressions will be 100-120 a minute, the actual number delivered will be fewer because of the pauses to give breaths.

‍

Depth of Compressions

According to the American Heart Association guidelines, the depth of compression ratio for children is at least one-third of the diameter of the chest, which is about 2 inches or 5cm, with a compression rate of 100-120 per minute.

‍

Rescue Breathing

The ventilation rate for a child that isn't breathing is 12 to 20 rescue breaths per minute. This is about one rescue breath every 3 to 5 seconds.

To do rescue breathing for a child, put one hand on the forehead, and push with your palm to tilt the head back. Then, take a normal breath, and blow it to the mouth of the child for 1 second. Watch to see if the child's chest rises.

‍

CPR Ratios for Infants

CPR is performed when an infant is unconscious, they're unresponsive, or if they're not breathing. CPR will keep the oxygenated blood moving through the infant's body with proper chest compressions and rescue breathing until advanced life support is available. If you are a parent, baby sitter of childcare provider, enroll in an Infant CPR Course to gain a better understanding about infant CPR.

Compression to Ventilation Ratio

The compression to ventilation ratio for an infant is the same as the ratio for adults and children, which is 30:2 for single rescuer. This means you need to perform 30 chest compressions followed by two rescue breaths for infants. If there are two rescuers, the ratio of compressions will be 15:2.

According to the American Heart Association and ILCOR, it is permitted to perform “hands-only” CPR on adults and older children. But for infants, it’s recommended to weave in the two breaths every 30 compressions.

‍

Rate of Compressions

The technique for performing chest compressions on infants differs from that for adults or children, but the compression rate is still the same. Because an infant is more fragile, the external chest compression should be performed with only two fingers, at the center of the chest, just below the nipples. The rate of chest compressions for infants is approximately 100 to 120 compressions per minute. This means the rescuer should perform chest compressions at a rate of about 100 to 120 compressions in a one-minute cycle. Allow the chest to return to its normal position after each compression.

‍

Depth of Compressions

When performing chest compressions on infants, the rescuer should compress the chest to a depth of about 1.5 inches (4 cm). It is essential to avoid compressing too deeply, as an infant's chest is more delicate compared to an adult's. Do not compress over the xiphoid or ribs.

‍

Rescue Breathing

The ventilation rate for infants during CPR is approximately 1 breath every 3 to 5 seconds, which translates to about 12 to 20 breaths per minute. Each rescue breath should be delivered gently enough to see the infant's chest rise visibly. Avoid excessive ventilation.

‍

CPR Ratio for Special Circumstances

The proper CPR ratio vary for certain circumstances, such as pregnant individuals, the elderly, and patients with specific medical or physical conditions. It is essential to recognize these differences to provide effective and appropriate care during out of hospital cardiac arrest and in hospital cardiac emergencies. However, it's important to note that the CPR guidelines changes over time, so always refer to the most current recommendations from reputable organizations like the American Heart Association (AHA) or the American Red Cross.

Pregnant Individuals

For pregnant individuals experiencing out of hospital cardiac arrest, the main focus is still on providing high-quality CPR with a focus on chest compressions. The standard compression-to-ventilation ratio of 30:2 is generally recommended, similar to adult CPR. However, when performing chest compressions, rescuers should slightly modify hand placement to avoid putting excessive pressure on the abdomen, especially as the pregnancy progresses. It is essential to prioritize the safety of both the pregnant individual and the fetus while providing life-saving CPR.

Elderly Patients

For elderly patients, the overall approach to CPR remains the same as for adults. The compression-to-ventilation ratio of 30:2 is generally used, with the aim of delivering high-quality chest compressions and rescue breaths. Rescuers should consider the frailty and potential underlying health conditions of the elderly patient, which affects the force applied during chest compressions.

Patients with Medical or Physical Conditions

For patients with specific medical or physical conditions, the general CPR guidelines still apply, emphasizing the importance of early recognition, activation of emergency services, and high-quality chest compressions. Some medical conditions or physical limitations makes it challenging to perform rescue breaths effectively. In such cases, if the rescuer is not trained or uncomfortable with rescue breaths, hands-only CPR (chest compressions only) is an alternative. Hands-only CPR is still effective in maintaining blood flow and oxygenation for a short period until professional help arrives.

Understanding CPR Ratio

The CPR Ratio refers to the specific sequence of chest compressions and rescue breaths administered during cardiopulmonary resuscitation. It guides responders on the number of chest compressions to perform and how many rescue breaths to give to an individual experiencing cardiac arrest or a sudden cessation of breathing.

Different age groups require a different set standard for CPR ratios. For example, the compression ratio for a man with a round and larger chest requires a strong push, while for the elderly, pushing hard, fast, and deep causes ribs to break. The compression ratio for an infant is also different because it requires less effort.

During CPR, the primary goal is to keep the blood flowing and maintain oxygen circulation to vital organs, especially the brain. The CPR Ratio plays a critical role in achieving this objective. If the CPR Ratio is not used correctly, it leads to inadequate blood flow and insufficient oxygen supply to the brain, which can have severe consequences for the person in distress.

Why is the CPR ratio important in performing effective CPR?

The CPR ratio is important in performing effective CPR because it ensures adequate blood flow and oxygenation to the body's vital organs, especially the brain. When performing chest compressions, blood is pumped out of the heart and circulated throughout the body, providing oxygen to organs and tissues. Meanwhile, mouth-to-mouth resuscitation provides additional oxygen to the lungs, which helps maintain proper gas exchange.

The CPR Ratio serves three critical purposes that significantly impact the outcome of a cardiac emergency:

• Performing chest compressions in the correct ratio helps maintain blood circulation throughout the body, especially to the brain and other vital organs.
• The CPR Ratio includes rescue breaths, which deliver vital oxygen to the lungs and subsequently to the bloodstream. Oxygen is essential for the survival of organs, particularly the brain, which is highly sensitive to oxygen deprivation.
• By using the appropriate CPR Ratio, responders optimizes blood circulation and oxygen delivery, increasing the likelihood of restoring normal breathing and heart rate.

‍

Understanding the CPR Ratio is crucial for effective CPR, as it ensures the patient receives the right balance of chest compressions and rescue breaths. If the CPR ratio is not maintained correctly, it leads to inadequate blood flow and oxygenation, which causes brain damage or even death.

According to the study of data from the National Institutes of Health clinical trials network database, a combination of 107 compressions per minute and a compression depth of 4.7 cm might be the ideal target for rate and depth of chest compressions during CPR. The research also indicates that the use of an adjunct during CPR could lead to significantly improved outcomes when this target is adhered to.

How does the CPR ratio affect blood flow and oxygenation during CPR?

The CPR ratio affects blood flow and oxygenation during CPR by directly influencing the balance between chest compressions and rescue breaths. Compressions serve as a substitute for the heart's pumping action, allowing blood to circulate throughout the body. The CPR compression rate should be fast enough to create sufficient pressure to pump blood but not too fast that it doesn't allow enough time for the heart to refill between compressions.

Meanwhile, ventilations provide additional oxygen to the lungs, which is then circulated throughout the body. The rate of ventilation should be appropriate for each age group and should not cause excessive air to enter the stomach instead of the lungs.

By following the correct CPR ratio, blood flow, and oxygenation are maintained at optimal levels during CPR, increasing the chances of survival and recovery.

What can happen if the CPR ratio is incorrect during CPR?

If the CPR ratio is incorrect during CPR, it leads to inadequate blood flow and oxygenation, which causes serious complications or even death. If compressions are not performed correctly, blood cannot circulate properly, leading to organ damage and brain injury. Likewise, improper ventilation can cause air to enter the stomach instead of the lungs, leading to gastric distention and possible vomiting, which further compromise breathing.

In addition, incorrect CPR ratios causes physical trauma, such as broken ribs or punctured lungs. This is especially true for older adults with weaker bones or infants whose delicate bodies require gentler handling.

‍

Why is it important to give rescue breaths during CPR?

It is important to give rescue breaths during CPR because they help deliver oxygen to the lungs and subsequently to the bloodstream. When a person's heart stops beating, their body no longer receives oxygen-rich blood, which leads to brain damage or death within minutes. Rescue breaths help provide additional oxygen to the lungs, which chest compressions distribute throughout the body. This helps maintain proper oxygenation and prevents brain damage or other complications that occurs due to lack of oxygen.

In addition, rescue breaths also help remove carbon dioxide from the body, which can build up and lead to acidosis if not eliminated. Acidosiscauses further harm to the body and impair its ability to function properly.

‍

How is CPR performed differently when an advanced airway is in place?

When an advanced airway, such as an endotracheal tube or supraglottic airway, is in place during CPR, the technique for delivering chest compressions and rescue breaths are modified to optimize resuscitation efforts. The presence of an advanced airway allows for more effective ventilation and oxygenation, and it changes the way CPR is performed as follows:

Chest Compressions

• When an advanced airway is in place, chest compressions is delivered continuously without the need for pauses to provide rescue breaths. This technique is often referred to as "continuous chest compressions."
• The rescuer focus solely on delivering high-quality chest compressions at the recommended rate (100 to 120 compressions per minute) and depth (approximately 2 inches or 5 centimeters for adults).

Rescue Breaths

• With an advanced airway in place, the rescuer does not need to provide mouth-to-mouth rescue breaths. Instead, the use of a bag-mask device or mechanical ventilator is preferred to deliver ventilation.
• For intubated patients, a bag-mask device is connected directly to the endotracheal tube, and for those with supraglottic airways, the device is connected to the airway device.
• The rescuer delivers ventilations at a rate of approximately 1 breath every 6 to 8 seconds, ensuring adequate oxygenation.

Is CPR Ratio different in other countries?

The principles of CPR are generally consistent worldwide, but specific guidelines, including the recommended CPR ratios, vary slightly between countries and international organizations. The variations are often based on the latest scientific research, regional practices, and the availability of resources and medical expertise.

The core components of CPR, such as chest compressions and rescue breaths, remain constant regardless of the country. However, differences arise in the compression-to-ventilation ratio, the recommended depth and rate of compressions, and the use of specific devices or techniques.

How can rescuers maintain the appropriate CPR ratio during CPR?

To maintain the appropriate CPR ratio during CPR, rescuers should follow the guidelines set by the American Heart Association (AHA) and Emergency Cardiovascular Care (ECC). These guidelines provide clear instructions on the correct compression rate, ventilation rate, and ratio for each age group.

Rescuers should also receive proper training in performing CPR to ensure that they perform it correctly. They should attend courses and receive certification from recognized organizations such as the AHA or ECC.

It is also important for rescuers to regularly refresh their knowledge and skills through refresher courses or practice sessions. This helps ensure that they are up-to-date with any changes in guidelines or techniques and performs CPR effectively in an emergency situation.

In addition, using tools such as feedback devices or metronomes helps maintain the correct compression rate during CPR. These devices provide auditory or visual cues to indicate compressions' proper timing and force, helping rescuers maintain the appropriate ratio.

‍

How has the CPR ratio changed over the years based on scientific research?

Over the years, scientific research and advancements in resuscitation science have led to changes in CPR guidelines. Earlier guidelines suggested a 15:2 compression-to-ventilation ratio, but as research accumulated, the emphasis shifted towards simplifying techniques for bystanders and prioritizing chest compressions.

The current standard for adults is a 30:2 ratio, highlighting the importance of early and effective chest compressions in maintaining blood circulation during cardiac arrest. These changes aim to improve the overall efficacy of CPR and enhance survival rates.

‍

What is the physiological rationale behind the current recommended CPR ratios?

The physiological rationale behind the current recommended CPR ratios is to optimize the balance between chest compressions and rescue breaths. Chest compressions generate blood flow to vital organs, particularly the brain and heart, sustaining life until normal heart function is restored. Rescue breaths, on the other hand, provide oxygen to the lungs, supporting overall oxygenation. The 30:2 ratio ensures an adequate combination of these components, promoting oxygen delivery to organs and preventing irreversible damage during a cardiac arrest.

‍

In a drowning incident, should the CPR ratio be adjusted?

In a drowning incident, the priority is immediate initiation of CPR. While the recommended CPR ratio remains the same, which is 30:2, guidelines suggest a slightly faster rate of rescue breaths if the rescuer is trained and comfortable doing so. Drowning victims have compromised oxygen levels, making prompt CPR crucial for restoring oxygenation and preventing secondary complications. Early intervention with the standard CPR ratio, or adjusted rescue breaths, can significantly improve the chances of a positive outcome.

‍

How does the CPR ratio vary for a patient with a tracheostomy or advanced airway in place?

When a patient has a tracheostomy or an advanced airway in place, the emphasis shift more toward continuous chest compressions. In such cases, the need for rescue breaths is reduced or eliminated initially. The modified approach recognizes that the advanced airway facilitates better ventilation, and continuous chest compressions help maintain blood circulation. This adjustment reflects the evolving understanding of airway management during CPR, particularly in healthcare settings.

‍

What modifications to the CPR ratio are recommended for laypersons versus healthcare professionals?

The recommended CPR ratio is generally the same for laypersons and healthcare professionals, such as 30:2 for adults. However, healthcare professionals receives more extensive training and are capable of performing advanced interventions. For instance, healthcare professionals might opt for continuous chest compressions without interruptions for rescue breaths, especially if an advanced airway is in place. Laypersons are typically encouraged to follow the standard ratio to ensure effective and accessible CPR delivery.

‍

Are there any special considerations for CPR ratio in cases of hypothermia or drug overdose?

In cases of hypothermia or drug overdose, the standard CPR ratio of 30:2 remains applicable, but specific considerations address the underlying causes. For drug overdose, alongside CPR, the administration of specific antidotes, such as naloxone for opioid overdoses, is crucial. In hypothermia cases, continuous resuscitation efforts are often emphasized even in prolonged cases, acknowledging the potential for delayed recovery.

These considerations highlight the importance of tailoring CPR efforts to address the unique challenges presented by different medical conditions. Always refer to the latest guidelines for specific recommendations based on current scientific knowledge.

‍

Are there specific modifications to the CPR ratio for individuals with pacemakers?

No, there are no specific modifications needed for CPR on individuals with pacemakers. CPR compressions are performed as usual because pacemakers are designed to withstand external chest compressions without damage.

‍

Is there a different CPR ratio recommendation for patients with chronic respiratory issues?

There is no different CPR ratio recommended for patients with chronic respiratory issues. The standard CPR ratio of 30 compressions to 2 breaths is applied universally, regardless of underlying respiratory conditions​

‍

Can the CPR ratio change based on the cause of cardiac arrest?

No, the CPR ratio does not change based on the cause of cardiac arrest. Standard CPR guidelines states that 30:2 ratio is used for all causes of cardiac arrest, including trauma and heart disease, as they are designed to provide the best chance of survival across various scenarios​

‍

Does performing CPR with different ratios affect long-term outcomes for survivors?

No. Performing CPR with different ratios does not significantly affect long-term outcomes for survivors. Studies show that adhering to the recommended 30:2 ratio maximizes the effectiveness of CPR, while variations in ratios do not substantially improve or worsen long-term survival outcomes.

‍

How can proper CPR training help individuals understand the correct CPR ratio?

Proper CPR training can help individuals understand the correct CPR ratio by providing them with the knowledge and skills necessary to perform CPR effectively. During CPR training, individuals learn about the importance of maintaining the appropriate compression rate, ventilation rate, and ratio for each age group. They also learn how to perform proper chest compressions and rescue breaths, as well as how to use tools such as feedback devices or metronomes to maintain the correct compression rate.

‍

Learn CPR and Save a Life Today

Just as the CPR Ratio is important, so too is obtaining a CPR Certification, which ensures individuals are prepared to perform CPR in an emergency. According to statistical analysis, out-of-hospital cardiac arrest affects nearly 1000 Americans each day; when including in-hospital cardiac arrest, more than 500,000 adults suffer cardiac arrest each year in the United States. For out-of-hospital cardiac emergencies, it's important for first aiders to do CPR as soon as possible to increase the chance of survival while waiting for the emergency medical services team.

Basic and Advanced Life Support providers performing successful resuscitation contribute to the survival rates from hospital cardiac arrest. If most people knew how to perform CPR and use an AED, we could decrease the number of deaths from out-of-hospital cardiac emergencies. At CPR Select, we want to help save lives by teaching you CPR and basic life support skills based on American Heart Association guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. You can save a life by learning how to do rescue breathing or CPR quickly and easily through one of our online classes. We can help you how to get a cpr certification quickly.

With CPR Certification, you will be equipped to provide effective CPR using the correct CPR Ratio, which increases a patient's chance of survival. Our CPR Certification course is divided into several modules, each focusing on a different aspect of CPR, including the CPR Ratio. The CPR Certification test will assess your understanding of the CPR Ratio and your ability to apply it in practice.

‍

Sources:

• AHA Guidelines for CPR and ECC
• ILCOR CoSTR Documents
• Increased chest compression to ventilation ratio improves delivery of CPR (PubMed)