A nurse is performing cardiopulmonary resuscitation (CPR) on a 3-month-old infant who became unresponsive during a routine examination. Which action should the nurse perform first when initiating infant CPR?

Initiating Resuscitation on an Unresponsive Infant

When an infant becomes unresponsive, the immediate priority is to determine if the infant requires cardiopulmonary resuscitation (CPR) while simultaneously activating the emergency response system. The foundational sequence for a single rescuer encountering a pediatric victim begins with verifying unresponsiveness, assessing for breathing, and calling for help. This approach prevents delays in both basic life support and the arrival of advanced care.

The First Step: Assessment and Activation

The correct initial action is to check for responsiveness and breathing while simultaneously calling for help. For a 3-month-old infant, responsiveness is assessed by tapping the sole of the foot or gently stimulating the infant, not by shaking. Simultaneously, the nurse should look for normal breathing, characterized by a regular rise and fall of the chest, while also scanning for gasping, which is an abnormal, agonal breathing pattern indicative of cardiac arrest ^[1]. If the infant is unresponsive with absent or only gasping respirations, the rescuer must immediately shout for nearby help to activate the emergency response system and retrieve an automated external defibrillator (AED) before proceeding to the next steps of the CPR sequence (C-A-B: Circulation, Airway, Breathing). The 2025 Korean guidelines reinforce this systematic approach, emphasizing that early recognition and activation are critical links in the chain of survival for pediatric cardiac arrest ^[2].

Why Other Actions Are Not First

Beginning chest compressions, opening the airway, or delivering rescue breaths are all vital components of high-quality CPR, but they follow the initial assessment and call for help. The 2023 International Consensus on Resuscitation highlights that the sequence of actions is designed to minimize interruptions and ensure that compressions are started as soon as possible after a cardiac arrest is recognized and help is on the way ^[1]. For a single healthcare provider, performing a rapid assessment while calling out for assistance ensures that the infant receives both immediate life support and the benefit of a team-based response with an AED, which is essential for treating shockable rhythms. Starting compressions without first calling for help delays the arrival of this critical equipment and additional personnel.