Pediatric Cardiac Arrest Algorithm

This algorithm provides a structured approach to managing pediatric cardiac arrest, detailing steps for immediate intervention, rhythm checks, defibrillation, and advanced care, tailored to the specific needs of pediatric patients.

Initial Response and Resuscitation Setup

Shout for Help/Activate Emergency Response: Immediately call for help and activate the emergency response system upon recognizing cardiac arrest.

Start CPR: Begin high-quality CPR with an emphasis on minimizing interruptions and maintaining adequate compression depth and rate. If no advanced airway is in place, maintain a 15:2 compression-to-ventilation ratio. Once an advanced airway is established, provide 8-10 breaths per minute with continuous chest compressions.

Attach Monitor/Defibrillator: Apply a defibrillator or monitor as soon as possible to assess the cardiac rhythm.

Defibrillation and Medication

Check Rhythm and Defibrillate if Shockable (VF/VT): Administer an initial shock of 2 J/kg. If the rhythm remains shockable, deliver subsequent shocks with increasing energy (second shock at 4 J/kg, then at least 4 J/kg, maximum 10 J/kg or adult dose).

Administer Epinephrine: Give epinephrine IV/IO at 0.01 mg/kg (0.1 mL/kg of 1:10,000 concentration) every 3-5 minutes. If IV/IO access is not available, administer an endotracheal dose of 0.1 mg/kg (0.1 mL/kg of 1:1000 concentration).

Amiodarone for Refractory VF/VT: If VF or pulseless VT persists after CPR and initial defibrillation, administer amiodarone IV/IO at 5 mg/kg, which may be repeated up to two times.

Advanced Airway and Continuous Care

Advanced Airway Management: Consider endotracheal intubation or placement of a supraglottic advanced airway. Use waveform capnography to confirm and monitor placement.

CPR Quality Focus: Ensure compressions are hard and fast (at least 100/min) and allow complete chest recoil. Rotate compressor every 2 minutes to avoid fatigue.

Assessment and Reversible Causes

Re-evaluate Rhythm: Regularly check the cardiac rhythm. If shockable, continue with shocks and CPR as previously described. If asystole or PEA, switch to the PEA/Asystole pathway.

Look for and Treat Reversible Causes: Identify potential reversible causes throughout the resuscitation process, such as hypovolemia, tension pneumothorax, hypoxia, tamponade, acidosis, toxins, electrolyte imbalances, thrombosis, hypothermia, and hypoglycemia.

Post-Resuscitation Care

Return of Spontaneous Circulation (ROSC): Once ROSC is achieved, proceed to post-cardiac arrest care to stabilize the patient and prevent further complications.