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Pediatric Cardiac Arrest Algorithm - Updated 2018

Cardiac Arrest is the cessation of blood circulation due to absent or ineffective cardiac mechanical activity. Clinically, the patient is unresponsive, not breathing or only gasping, and there is no detectable pulse. Cerebral hypoxia causes LOC and failure to breathe. Agonal breaths may be observed during the first minutes after cardiac arrest.

Pediatric Cardiac Arrest Algorithm Download Printable Algorithm

Algorithm Notes

STEP 1

CPR

As soon as cardiac arrest is determined in a pediatric patient, initiate high quality CPR starting with compressions.

Attach an ECG monitor or AED pads as soon as they become available while minimizing pauses in CPR. Once the monitor or AED pads are attached, determine whether the rhythm is shockable(VF/VT) or nonshockable (asytole/PEA). If the rhythm is shockable proceed to Step 2. If the rhythm is nonshockable proceed to Step 9.

STEP 2

Shockable Rhythm: VF/VT

Make sure to keep performing CPR while the defibrillator is charging.

STEP 3

Administer Shock

Deliver 1 unsynchronized shock using an AED or Manual Defibrillator.

AED
Over 8 years old: Standard AED with adult pad-cable system.
Between 1-8 years old: AED with attenuated does if available.
Less than 1 year old: Use a a manual defibillator if available or attenuated dose if available.

Manual Defibrillator
Start with an initial dosage of 2-4 J/kg.

STEP 4

Resume CPR and Gain IV/IO Access

Immediately after the shock, resume CPR beginning with chest compressions.

While CPR is being performed, another member of resusitation team should gain IV or IO access

After 2 minutes of high quality CPR, check the rhythm. If VF/VT persists, proceed to step 5. If the rhythm is unshockable, proceed to step 12.

STEP 5

Administer Shock

Deliver a shock with an AED or with a dose of 4 J/kg on a manual defibrillator.

STEP 6

Resume CPR and Administer Epinephrine

Resume chest compressions immediately after shock. The rescuers should have switched positions at this point and traded compressors.

Administer Epinephrine:
IO/IV: 0.01 mg/kg (0.1 mL/kg) bolus (1:10 000)
ET: 0.1 mg/kg (0.1 mL/kg) bolus (1:1000)
Repeat epinephrine about every 3 to 5 minutes of cardiac arrest.

Consider insertion of an advanced airway if one is not in place.

After 2 minutes of high quality CPR, check the rhythm. If VF/VT persists, proceed to step 7. If the rhythm is unshockable, proceed to step 12.

STEP 7

Administer Shock

Deliver a shock with an AED or with a dose of 4 or more J/kg on a manual defibrillator (Max of 10 J/kg).

STEP 8

Resume CPR and Administer Antiarrhythmic Medications

Resume chest compressions immediately after shock. The rescuers should have switched positions at this point and traded compressors.

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STEP 9

Nonshockable Rhythm

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STEP 10

CPR and Administer Epinephrine

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STEP 11

CPR and Treat Reversible Causes

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ACLS Recertification

129

The Advanced Cardiac Life Support (ACLS) Recertification teaches medical professionals how to respond to nearly all cardiopulmonary emergencies.

PALS Recertification

129

The Pediatric Advanced Life Support (PALS) Recertification teaches medical professionals to manage and respond to cardiopulmonary resuscitation of pediatric patients in emergency situations.

BLS Recertification

65

The Basic Life Support (BLS) Recertification is intended to teach healthcare professionals the basic steps of CPR and rescue breathing for adults, children and infants.

CPR Recertification

35

Cardiopulmonary Resuscitation, Automated External Defibrillator (AED) and First Aid Recertification is designed to teach adult and child CPR and AED use, infant CPR, and how to relieve choking in adults, children and infants.

ACLS Certification

179

The Advanced Cardiac Life Support (ACLS) Certification teaches medical professionals how to respond to nearly all cardiopulmonary emergencies.

PALS Certification

179

The Pediatric Advanced Life Support (PALS) Certification teaches medical professionals to manage and respond to cardiopulmonary resuscitation of pediatric patients in emergency situations.

BLS Certification

95

The Basic Life Support (BLS) Certification is intended to teach healthcare professionals the basic steps of CPR and rescue breathing for adults, children and infants.

CPR Certification

39

Cardiopulmonary Resuscitation, Automated External Defibrillator (AED) and First Aid Certification is designed to teach adult and child CPR and AED use, infrant CPR, and how to relieve choking in adults, children and infants.

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