Chest compressions

Indication

If after 30 seconds of effective bag and mask ventilation with 100% oxygen,

heart rate is below 60 per minute

When to stop chest compressions

When heart rate is 60 per minute or more

Principle

Pump out blood from the heart during compression and fill up blood in the heart during release

Must always be accompanied by ventilation with 100% oxygen

Mechanism of Chest Compressions

Compress Release

heart heart

sternum

Components

Position Neck slightly extended with firm support for the back Lower 1/3rd of sternum between nipple line & sternum

Pressure required – depth 1/3rd of the AP diameter of chest

Rate 90/min

Chest Compressions

Position Lower third of sternum Between nipple line and

xiphisternum

Techniques of Chest Compressions

Thumb method Two-finger method

Techniques

Thumb technique Two-finger technique

# Do not remove thumbs/finger from chest

Thumb technique

Thumbs on sternum, hands on torso & finger supporting the back

Thumbs flexed at the first jointPressure applied vertical

Chest Compressions

2-finger technique

Easier with right hand for right handed

Index and middle or ring fingers Other hand used to support the back Pressure applied vertically

Chest Compressions

Preferred method - thumb

Advantages Better control of depth Less tiring Superior generation of peak systolic & coronary

perfusion pressure Nails do not hinder performance

Disadvantages Difficult when baby is big Umbilicus difficult to cannulate.

Compression

One compression consists downward compression plus the release

Actual distance is not a number but depends on size of baby

Duration of the downward stroke should be shorter than release to produce max COP

Rate & adequacy

Rate 3 CC then 1 ventilation (1:3) 90 CC to 30 ventilation in one minute

Adequacy Palpate femoral/carotid pulse

Cycle of events

One – and – two –and – three – and – breathe – and

Consists of 3 compression & one ventilation

120 events in 60 seconds 1 cycles in 2 seconds

Chest Compressions Dangers Broken ribs Lacerated liver Pneumothorax

Precautions No pressure on the ribs, xiphisternum,

abdomen Do not lift thumbs/fingers

Evaluation after 30 sec of CC & BMV

HR 60 per minute or more Stop CC, continue BMV at 40-60/min

If no improvement, check :Effectiveness of BMVOxygen is 100%Technique of CC is correct

Key points

When to do? Why to do ? How to do? Which is best ? When to stop ? What if fails ?