Assessment of infant cardiopulmonary resuscitation rescue breathing technique: Relationship of infant and caregiver facial measurements

Objective. Although a few infants ever require resuscitation, pediatric car diopulmonary resuscitation (CPR) is performed most commonly under 1 year of age. American Heart Association guidelines for pediatric basic life suppor t recommend that the caregiver place his/her mouth over the infant's mouth and nose to create a seal. The way CPR is currently taught encourages paren ts to attempt to seal the nose and open the mouth of the infant for rescue breathing. Recent studies suggest some parents may have trouble sealing an infant's nose and open mouth, but their study participant numbers were smal l. The aim of this report is to estimate, among a large cohort, the ability of caregivers to create a seal to their infants for the provision of rescu e breathing according to current guidelines. Methods. Infants up to 1 year of age (n = 281) and their caregivers were en rolled from Philadelphia pediatric offices. Facial measurements of the infa nts were obtained to estimate the length needed to seal the nose and open m outh, and the nose and closed mouth. Mouth widths of the caregivers were co mpared with their infant's nose and mouth lengths. One-way analysis of vari ance with Tukey's postmortem analysis and ordinary least squares means regr ession were used for univariate analysis with analysis of covariance used t o control for the effects of multiple variables when necessary. Infant meas urements were stratified into 8-month age quadrants to compare against matc hed adult caregiver measurements. Results. Most caregivers (n = 270) were female. Females had smaller mouth w idths than males (4.9 +/- 0.5 cm vs 5.2 +/- 0.5 cm). Infant nose and mouth length increased during the first year of life, with the largest increase b etween 0 to 3 months and 3 to 6 months (4.2 +/- 0.4 cm to 4.7 +/- 0.4 cm). As infant age and face length increased, a progressively higher rate of adu lt females were estimated not to be able to cover their infant's nose and o pen mouth, with the greatest increase again between 0 to 3 months (9%) and 3 to 6 months (40%). All female caregivers except 1 were predicted to be ab le to seal their infant's nose and closed mouth by our measurements. Conclusions. Infant face length grows rapidly during the first year of life with the most rapid growth occurring during the first 6 months. As early a s 3 to 6 months of infant age, many adult caregivers' facial measurements, especially female, predict that they may not be able to form a seal for mou th-to-nose and open-mouth infant rescue breathing. By related measurements, nearly 100% of caregivers should be able to seal their infant's nose and c losed mouth. If facial measurement predictions correlate with functional in ability to seal an infant's nose and open mouth, infant CPR rescue breathin g instruction will need to emphasize head position and creation of a seal l over the mouth and nose without teaching that the mouth be open.