Guidelines are changed to reflect survival rates of cardiac arrest in the UK and extensive research is conducted prior to making these recommendations.

The new guidelines for CPR carried out has been released by the Resuscitation Guidance Council on the 5th May 2021. The changes include: 

• There are no major changes in the 2021 Basic Life Support Guidelines when giving CPR to adults.
• There is an increased emphasis on communicating with ambulance emergency medical advisors to receive instructions for confirming cardiac arrest, starting compression-only CPR, and locating, retrieving, and using an AED.
• Provide chest compressions as soon as possible after cardiac arrest is confirmed.
• Send someone to fetch an AED and bring it to the scene of the cardiac arrest. The British Heart Foundation database, “The Circuit” serves as a national resource for the location of AEDs.
• There is more emphasis or recognising agonal breathing and what a cardiac arrest may look like. "A short period of seizure-like movements can occur at the start of cardiac arrest. Assess the person after the seizure has stopped: if unresponsive and with absent or abnormal breathing, start CPR".

  Babies and Children

 There are more changes to the resuscitation methods for babies and children.

• Firstly, it is now recommended that first aiders assess for signs of life (circulation) simultaneously with breathing assessment and during the delivery of rescue breaths.  
• If there are no signs of life, chest compressions should be started immediately after rescue breaths have been delivered. 
• There is emphasis on rescuers using mobile phones with speaker function to work with the emergency medical advisors in the ambulance service to deliver effective and quick CPR. 
• In certain situations, such as when the child or infant is breathing spontaneously but requires airway management or when the child has a traumatic injury, the recovery position is not recommended. 

 Chest compression in infants ( under 1).

• The infants head should be in a neutral position is now emphasised.  
• There is now the introduction of the encircling technique for chest compression in infants – be careful to ensure complete chest recoil after each chest compression. Single rescuers might alternatively use a two-finger technique. 

If a child’s breathing is abnormal or absent (age group 1 to puberty).

• Give 5 initial rescue breaths. 
  • Although rescue breaths are described here, it is common in healthcare environments to have access to bag-mask devices and providers trained in their use should use them as soon as they are available. In larger children when BMV is not available, competent providers can also use a pocket mask for rescue breaths.  
  • While performing the rescue breaths, note any gag or cough response to your action. These responses, or their absence, will form part of your ongoing assessment of ‘signs of life’. 
  • Ensure head tilt and chin lift, extending the head into 'sniffing’ position. 

For both infants and children, if you have difficulty achieving an effective breath, the airway may be obstructed: 

• Open the child’s mouth and remove any visible obstruction. Do not perform a blind finger sweep. 
• Ensure that there is adequate head tilt and chin lift but also that the neck is not over extended; try repositioning the head to open the airway. 
• If head tilt and chin lift has not opened the airway, try the jaw thrust method. 
• Make up to 5 attempts to achieve effective breaths. If still unsuccessful, move on to chest compressions.  

Changes to chest compressions  

• Rate: 100-120 min^-1for both infants and children remain the same.
• Depth: depress the lower half of the sternum by at least one third of the anterior–posterior dimension of the chest (which is approximately 4 cm for an infant and 5 cm for a child). 
• Compressions should never be deeper than the adult 6 cm limit (approx. an adult thumb’s length).  
• Emphasis on minimising pauses so that 80% or more of the CPR cycle is comprised of chest compressions.
• Finger position methods have changed.
• Chest compression numbers have now changed.
• After 30 compressions, tilt the head, lift the chin, and give rescue breaths. 
• Continue compressions and breaths in a ratio of 30:2.
• Perform compressions on a firm surface. 

The best method for compression varies slightly between infants and children. 

Chest compression in infants: 

• The introduction of the encircling technique - Preferably use a two-thumb encircling technique for chest compression in infants – be careful to ensure complete chest recoil after each chest compression. Single rescuers might alternatively use a two-finger technique. 

Continue resuscitation until: 

• The child shows signs of life (e.g., normal breathing, cough, movement).
• Additional qualified help arrives.
• You become exhausted. 
• Move a child in the recovery position every 30 minutes to avoid too much pressure on their chest which may make breathing harder.

https://www.resus.org.uk/library/2021-resuscitation-guidelines/paediatric-basic-life-support-guidelines