Performing CPR, or cardiopulmonary resuscitation, on an infant can be quite stressful but may be necessary to sustain life in an unconscious infant. It is rare for infants to go into cardiac arrest unless there is an underlying heart condition. Infants can also go into cardiac arrest because of an unresolved breathing emergency related to an airway obstruction, drowning or allergic reaction.
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Part of the initial assessment on an unconscious infant involves a quick check for breathing and circulation. If the baby is not breathing after a 10-second check, two small breaths are offered. After the two breaths, it is important to check for any signs of circulation. If the skin is cool, pale or bluish, and the baby is still not breathing, it is fair to assume that the heart is not pumping. To further verify this, a pulse check can be performed. In an adult or child, the pulse is checked in the carotid artery of the neck; in an infant, the brachial artery of the arm is checked. If there is no discernable pulse, chest compressions are recommended.
Locating the Brachial Artery
The brachial artery is on the underside of the arm between the armpit and the elbow. Anatomically, it lies between the triceps and the biceps. Because this artery is close to the surface, a pulse can be determined with a light touch. Infants have a much faster heart rate than adults. According to the American Academy of Family Physicians, a newborn has a resting heart rate between 120 and 160 beats per minute, which is about twice that of an adult. A fast pulse is often harder to detect.
Brachial Artery vs. Carotid Artery
The brachial artery is checked instead of the carotid artery for several reasons. Anatomically, the necks of babies are shorter, making a carotid pulse hard to locate. Finding a carotid pulse on an adult or child is much simpler when the head is extended back, exposing the carotid artery. Since babies are more fragile, extending the neck of an infant is not recommended. Tilting the head back too far can also close off the trachea, the airway that leads to the lungs.
For rescuers who aren't health care professionals, the American Heart Association doesn't even recommend a pulse check during an initial assessment on an infant. The pulse is somewhat hard to locate and accurately assess, and attempting to do so takes 10 seconds or more, which is time away from the important chest compressions. So after the two breaths, if the infant is still not breathing, the rescuer would immediately begin chest compressions. Health care providers do check and monitor infant pulses, because they have been trained to do so. The American Red Cross continues to teach lay rescuers to check the brachial pulse as part of its infant CPR program.
Reasons for Change
About every five years, professional organizations revisit the guidelines for cardiac life support. In 2005, the American Heart Association, among others, changed the assessment sequence for lay rescuers. It found that lay rescuers generally were not well-versed in a checking a pulse, meaning that chest compressions were either delayed or not performed at all because of uncertainty about a pulse. Since relatively little harm can be done to the infant in the event chest compressions are not needed, the heart association determined that a pulse check is unnecessary, as it is far worse to deny a baby the valuable chest compressions.