Out of hospital protocol
Collapsed unresponsive patient 
5 cycles (2 minutes) of CPR then call 911 if alone; get someone else to call 911 immediately, if possible.
Airway
- Open airway, check breathing. If not breathing, give 2 breaths. If initial attempt unsuccessful, reposition and try to give breath. If unsuccessful, assume obstructed airway.
- No Trauma: Head tilt/Chin lift
- Trauma: Jaw thrust with inline C-spine immobilization
Breathing; Initial
Confirm patient isn't breathing; then give 2 breaths at 1 second/breath [look for chest rise]. If no chest rise; reposition airway and attempt again. If airway obstructed; deliver 5 back blows followed by 5 chest thrusts and repeat until obstructed airway relieved or infant becomes unconscious. If unconsciousness occurs, look in the mouth to see if object present, then attempt breath, reposition if breath doesn't go in and reattempt. Follow attempts at ventilation with chest compressions and then continue with breaths after looking in mouth for object.
Breathing (Rescue breathing, no CPR)
20 breaths per minute (only if definite pulse >60 BPM, otherwise provide chest compressions). Pulse check every 2 minutes.
Breathing; CPR ongoing [No advanced airway]
- Single Rescuer: 2 breaths then 30 compressions
- Two Rescuers: 2 breaths then 15 compressions
- Compressions paused for breaths
Breathing; CPR ongoing [Advanced airway]
100 compressions/min with 8-10 breaths/minute with no pauses for breaths
Circulation; Pulse check
- Site: Brachial
- Duration: 10 seconds (30-45 seconds if hypothermia)
Circulation; Chest compressions
Rate/Ratio: 30 compressions then 2 breaths at rate of 100/minute (if advanced airway then 100 compressions/minute with no pauses for 8-10 breaths/minute).
Compression technique
Compress 1 finger's width below nipple line using 2-3 fingers or encircling the chest and using 2 thumbs (if 2 rescuers). Depth of compressions to be 1/3 to 1/2 of the depth of the chest or approximately ½-1 inch.
Ratio Compressions:Ventilations
- Basic Airway:
- 30:2 single rescuer
- 15:2 for 2 rescuers
- Advanced airway:
- Give compressions at 100/minute and give a breath every 6-8 seconds (8-10 breaths/minute).
Defibrillation; AED
AED's are not to be used in the <1 year age group. In this age group, CPR to continue until ALS responders arrive [standard defibrillator can be used in this age group, but not AED]
Source: Circulation 2005;112. 2005 AHA Guidelines for CPR and ECC.