Cardiopulmonary Resuscitation (CPR) for a Child with a Tracheostomy

If you are unable to wake your child and they are not responding when you tap them, you need to start CPR by following the steps below.

NOTE: These directions include using your resuscitation (Ambu) bag. If oxygen is available, attach the Ambu bag at the flow rate prescribed by your company. You should always carry your ambu bag in your Go Bag, but if it is not available, you will need to perform CPR using the mouth to trach tube method as taught in the Parent CPR Class.

  1. Gently tap to see if child responds. If no response, call out for help. Turn your child onto his/her back and place on flat, hard surface.
  2. Tilt head back in head-tilt/chin-lift position. Placing a small rolled up towel or blanket under the shoulders may make it easier to get at the trach.
  3. Look, listen, and feel for air coming from the trach, nose or mouth. Look to see if the chest is going up and down.
  4. If there is no air passing in and out, attach the Ambu bag to the trach tube and give 2 breaths. If someone else is with you, ask him/her to pinch the child’s nose and keep the child’s mouth closed while you give the breaths through the trach tube.
    • IF AIR GOES IN (chest rises), BEGIN CPR, GO TO STEPS 6-10.
    • IF AIR DOES NOT GO IN, FOLLOW STEP 5.
  5. Suction trach tube. Use saline before suctioning if a mucus plug might be present.
    • Attempt 2 breaths with ambu bag again. If breaths go in (chest rises) begin CPR, GO TO STEPS 6-10.
    • If breaths do not go in (chest does not rise), change trach tube.
    • Attempt 2 breaths. If air does not go in (chest does not rise) pull out the trach tube. Attach the face mask to the Ambu bag. If someone else is with you ask him/her to cover the stoma while you give the breaths using the face mask. BEGIN CPR, GO TO STEPS 6-10.
  6. BEGIN CPR:
    To start compressions place the heel of one hand (or 2 hands for a larger child) on the center of the chest. For infants, less than 1 year of age, place two fingers on the center of the chest just below the nipple line.
  7. When doing the compressions, push hard and push fast. Push down one third to one half the depth of the chest. Allow the chest to recoil after each compression.
  8. Each CPR cycle is 30 compressions and 2 breaths. You will need to go quickly from the breaths to the compressions and back to the breaths.
  9. Call 911 after two minutes of CPR (about 5 cycles). Do not leave the child alone. You may carry the child with you to a phone to call for help if necessary.
  10. Continue doing 30 compressions and 2 breaths until help arrives.

This information was obtained in part from the American Heart Association; "Pediatric Basic Life Support"

Disclaimer: This information is not intended to substitute or replace the professional medical advice you receive from your child's physician. The content provided on this page is for informational purposes only, and was not designed to diagnose or treat a health problem or disease. Please consult your child's physician with any questions or concerns you may have regarding a medical condition.

Reviewed: 04/07