CPR for children with a tracheostomy tube (over 12 months)

Introduction

Cardiopulmonary resuscitation (CPR) is a life-saving procedure that is used in emergencies.

It involves: 

  1. chest compressions to help circulate blood through the body
  2. rescue breaths to give oxygen to the lungs. 

Anyone can perform CPR, even if you are not a health professional. Attempting CPR is always better than doing nothing.

CPR can be lifesaving when a child is:

  • unconscious or collapsed
  • not responding to you
  • not breathing, or is breathing abnormally
  • having heart issues or their heart has stopped.

CPR is slightly different for children over 12 months who have had a tracheostomy procedure. This is because they have a tube in their airway.

This fact sheet does not replace accredited CPR or first aid training courses.

CPR for children with a Tracheostomy (over 12 months old)

DRS ABCD is a quick, seven-step process that will help you give CPR appropriately.
 

DRS ABCD for children with a tracheostomy can be slightly different, so use the below as a guide and speak to your child’s treatment team for more information or training.
 

Check for DANGER

Check for danger to yourself, the child and anyone else in the area.

If it is safe to do so:

  • move the danger out of the way
  • move your child and yourself away.

For example, if your child becomes unconscious in the water, you will take them out of the water to remove the danger.

Check for RESPONSE

Use “talk and touch” to check for a response.

  1. place one hand on your child's forehead
  2. place your other hand on your child's shoulder and squeeze gently
  3. speak to your child in a loud but gentle voice.

Do not shake your child. This can cause serious injury and death.

Your child may respond by:

  • opening their eyes
  • making a noise
  • moving their body.

If your child responds, place them on their side. Keep them comfortable while you watch them.

If you are worried, see your local doctor or go to your nearest emergency department.

SEND for help

If your child is not responding, call an ambulance on:

  • Triple Zero (000) 
  • The international emergency number (112) from digital mobile phones only.

Ask someone nearby to call the ambulance and wait with you if possible.

Put the phone on speaker and follow any instructions.

You must tell the person on the phone that your child has a tracheostomy tube and needs CPR.

Open the AIRWAYS

Check that your child’s airways are open by:

  1. laying them on a firm surface, on their back
  2. using your fingers to lift their chin upwards so you can see the tracheostomy tube.

To check the tracheostomy tube, you will need to remove the humidifier and suction out any material that you can see.
You may need to replace the tracheostomy tube to properly remove a blockage.

Check BREATHING

Check that your child is breathing by supporting the newly inserted tracheostomy tube and:

  • LOOKING to see whether their chest and stomach are moving
  • LISTENING for the sound of air coming from the tube
  • FEELING whether there is air coming from the tube.

Do this for ten seconds. If your child is not breathing or is breathing abnormally, you will need to start rescue breaths.
 

  1. place your mouth or a resuscitation bag over the tracheostomy tube
  2. gently blow or give two breaths 
  3. look to see whether your child's chest is rising and falling with each breath.

If your child starts to breathe normally after rescue breaths, roll them onto their side and stay with them until the ambulance arrives.

Start CPR

If your child is still not responding or breathing properly, you will need to start CPR.

To perform CPR:

  1. place the heel of your hand on the centre of your child's chest, around the lower half of their breastbone
  2. place your other hand on top, if your child is older or bigger
  3. push your child's chest down by about 1/3 of its depth, at a fast pace of around 100-120 compressions per minute
  4. repeat this 30 times before giving two breaths through the tube, as you did before.
  5. watch to see the child’s chest rise and fall.

Continue the cycle of 30 pushes and 2 breathes until:

  • your child starts to respond – they move, start to breathe normally, cry or cough
  • the ambulance arrives and a paramedic takes over from you.

If your child starts to respond, roll them onto their side and stay with them until the ambulance arrives.

If you become tired and cannot continue safely, ask another adult close by to take over for a few cycles. 

If you are unable to or prefer not to give breaths, continue to give chest compressions without stopping until the ambulance arrives.

DEFIBRILLATION or an AED

An Automatic External Defibrillator (AED) is a portable device that gives an electric shock to get the heart beating normally again. They are programmed to automatically analyse your child’s heartbeat and give an appropriate shock.

AEDs are commonly found in public places like:

  • shopping centres
  • airports
  • workplaces
  • parks
  • community centres.

An AED should be used if one is available. Ask a nearby adult to find the closest AED and bring it to you while you stay on the phone with Triple Zero (000) and continue with CPR.

Turn the AED on, switch it to the right setting based on your child’s age and follow the prompts.

Last updated Monday 6th May 2024

Disclaimer

This factsheet is provided for general information only. It does not constitute health advice and should not be used to diagnose or treat any health condition.

Please consult with your doctor or other health professional to make sure this information is right for you and/or your child.

The Sydney Children’s Hospitals Network does not accept responsibility for inaccuracies or omissions, the interpretation of the information, or for success or appropriateness of any treatment described in the factsheet.

© Sydney Children’s Hospitals Network 2024


This factsheet was produced with support from John Hunter Children's Hospital.