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TRACHEOSTOMY 
CARDIOPULMONARY RESUSCITATION (CPR) 

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. 

CPR is the act of pushing hard and fast on the chest and giving breaths to someone whose heart has stopped pumping blood. Pushing on the chest pumps blood to the brain and heart. When the breaths from the Ambu bag make the chest rise, you know the child or infant is getting enough air. One set of CPR is 30 pushes and 2 breaths. 

Hand or Finger Placement for Chest Pushes in CPR 
Child older than 1 year and has not reached puberty:

  • Place the heel of one hand on the lower half of the breastbone. If you cannot push deep enough with the heel of one hand, you can use two hands. Two hands: interlock your fingers and place the bottom hand on the lower half of the breastbone.
  • Push straight down on the chest about 2 inches
Infant younger than 1 year old
  • Place 2 fingers on the breastbone just below the nipple line.
  • Push straight down on the chest about 1 ½ inches.
A child who “responds” moves, speaks, blinks or reacts in some way when you tap him and ask if he is OK. 
A child who does not “respond” is not breathing and does nothing when you tap him and ask if he is OK.  

Automated External Defibrillator (AED): An AED has computer that tells you if a shock is needed to make the heart work properly. The best chance of saving a person’s life is to start CPR right away and use an AED within a few minutes.  Use the AED as soon as you have it. Turn it on and follow the prompts. Use child pads or child key if available. Use adult pads if the AED does not have child pads. 

CHECK FOR RESPONSE, GET HELP:
  1. Make sure the scene is safe.
  2. If the infant or child does not respond:
    • Yell for help.
    • If help is available tell him to call 9-1-1 first and to look for an AED.
  3. Turn the child onto his back and place him on flat, hard surface. Place the infant on his back on a flat, hard surface above the ground if possible.
  4. Check breathing – No response + no breathing or only gasping = Give CPR
PUSH ON THE CHEST:
  1. Move clothing out of the way.
  2. Find correct hand or finger placement for CPR.
    • Child: Place the heel of your hand on the lower half of the breastbone.
    • Infant: place 2 fingers on the breastbone just below the nipple line.
  3. Push hard and fast on the chest 30 times.
    • Child: Push straight down on the chest about 2 inches deep.
    • Infants: Push straight down on the chest about 1 ½ inches
    • Push at a rate of at least 100 times per minute.
    • Let the chest come back to its normal position between pushes.

GIVE BREATHS:

  1. Position the child with his head tilted back to expose the trach tube
    • Quickly look to be sure there is not a plug of mucus blocking the opening to the trach tube. If a mucus plug is present, remove it using your suction device.
  2. Attach the Ambu bag to the trach tube and attempt to give 2 slow breaths, each over 1 second. Watch for the chest to rise after each breath. If the chest does not rise, see NOTE below.
PHONE 9-1-1 and GET AN AED:
  1. After 5 sets of CPR, stop and phone 9-1-1 if no one has called.
  2. Get an AED if no one has brought one. If you cannot quickly locate an AED, return to the child or infant after you phone 9-1-1.
KEEP GOING: If you have an AED, turn it on and follow the prompts. If you do not have an AED, keep giving sets of 30 chest pushes and 2 breaths. Do not stop until the child or infant responds or someone with advanced skills arrives.

NOTE: Additional Considerations for Giving CPR to an Infant or Child with a Tracheostomy:
The current CPR guidelines recommend giving 30 pushes on the chest first and then giving 2 breaths when a person is unresponsive and needs CPR. However, if the chest does not rise when you give breaths, and you suspect that the trach tube needs to be suctioned or changed, you need to follow these steps to clear the child’s airway before you push on the chest again.

  1. If the chest does not rise, SUCTION the trach tube.
    • Use saline before suctioning if a mucus plug might be present.
    • Attempt 2 breaths with the Ambu bag.
    • If the airway was cleared, the chest will rise. Continue CPR.
  2. If the chest does not rise CHANGE the trach tube. Give two breaths.
    • If the chest rises, continue CPR.
  3. If the chest does not rise, REMOVE the trach tube.
    • Attach a face mask to the Ambu bag.
    • Tilt the head back and lift on the chin pulling it up to help seal the mask to the face.
    • If someone else is with you, ask him to cover the stoma while you give 2 breaths with the face mask. Continue CPR.
  4. After 5 sets of CPR phone 9-1-1 and get an AED. Keep going. Do not stop until the child or infant responds or someone with advanced skills 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: 05/2012