Pediatric Cardiac Arrest Algorithm
Algorithm at a Glance
- The provider immediately recognizes cardiac arrest and begins high-quality CPR.
- The team determines whether the cardiac arrest rhythm is shockable (VF or pVT) or nonshockable (PEA or asystole).
- If the rhythm is shockable, the team administers a shock as soon as a defibrillator is available.
- If the rhythm is not shockable, the team administers epinephrine as early as possible and every 3–5 minutes after that.
- High-quality CPR continues if the child remains in cardiac arrest.
- For VF or pVT, the provider considers antiarrhythmics if defibrillation is not successful.
Related Video – Understanding the Pediatric Cardiac Arrest Algorithm
Goals for Management
The provider must succeed in the following goals to successfully manage children in cardiac arrest:
- Recognize the rhythms of cardiac arrest: ventricular fibrillation, ventricular tachycardia, PEA, and asystole
- Recognize the Hs and Ts as possible causes of cardiac arrest
- Appropriately intervene in cardiac arrest depending on the cardiac arrest rhythm
Pediatric Cardiac Arrest Algorithm Explained
This algorithm outlines the steps for assessing and managing children presenting with cardiac arrest symptoms.
Box 0: Ensure Scene Safety
The provider surveys the scene to ensure that it is safe for rescuers and the child. If not, the provider carefully moves the child to a safe environment.
Box 1: Initiate CPR
The provider immediately initiates high-quality CPR. The team determines if the rhythm is shockable.
If shockable, the team proceeds to Box 2.
If not shockable, the team proceeds to Box 9
Box 2: Shockable Rhythms
The shockable rhythms are ventricular fibrillation and pulseless ventricular tachycardia.
Ventricular fibrillation is a shockable rhythm.
Box 3: Administer Shock
The initial shock is 2 J/kg.
Box 4: Provide High-Quality CPR for 2 Minutes
High-quality CPR includes:
- Rate 100–120 bpm
- Depth ≥ one-third the anteroposterior diameter of the chest
- Complete chest recoil
- Minimal interruptions
- Rotating compressors every 2 minutes or sooner if required
While CPR is in progress, another member of the team simultaneously obtains IV or IO access.
After 2 minutes, the team stops to determine if the child is still in a shockable rhythm.
If yes, the team proceeds to Box 5.
If no, the team proceeds to Box 12
Box 5: Administer Shock
The second shock is given at a dose of 4 J/kg
Rescuers administer shocks per the algorithm directives.
Box 6: Resume CPR for 2 Minutes
Simultaneously, another team member administers epinephrine every 3–5 minutes. The team leader considers the insertion of an advanced airway.
After 2 minutes, the team stops to determine if the child is still in a shockable rhythm.
If yes, the team proceeds to Box 7.
If no, the team proceeds to Box 12.
Box 7: Administer Shock
After the second shock (Box 5), all subsequent shocks are at 4 J/kg or higher to a maximum of 10 J/kg or an adult energy dose.
Box 8: Resume CPR for 2 Minutes
The team administers amiodarone or lidocaine.
The team assesses for and treats possible underlying causes (Hs and Ts).
The team continues with a rotation of shocks and CPR until the rhythm is not shockable.
Related Video – Introduction to the Hs and Ts
Box 9: Non shockable Rhythms
If the child’s rhythm is identified as asystole or PEA, the team starts an IV, administers epinephrine, and proceeds to Box 10.
Box 10: High-quality CPR for 2 Minutes.
A team member obtains IO/IV access and administers epinephrine if not already done.
The team considers an advanced airway and waveform capnography.
After 2 minutes of high-quality CPR, the team evaluates the rhythm.
If shockable, the team proceeds to Box 5 or 7.
If not shockable, the team proceeds to Box 11.
Box 11: Resume High-Quality CPR for 2 Minutes
The team leader considers and treats any reversible causes (Hs and Ts).
After 2 minutes, the team evaluates the rhythm.
If shockable, the team proceeds to Box 5 or 7.
If not shockable, the team proceeds to Box 12.
Box 12: Assess Non shockable Rhythm
If the rhythm is asystole or PEA, the team returns to Box 11.
Related Video – Hs and Ts: Treating Asystole
If the rhythm is organized, the provider assesses for a pulse.
The team should consider the appropriateness of continuing resuscitation.
If there is a pulse, the team proceeds to the Post-Cardiac Arrest algorithm.
Related Video – Immediate Post-Cardiac Arrest Care
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