Responding to Cardiac Arrest
Please purchase the course before starting the lesson.
The first management step in cardiac arrest is to begin high-quality CPR. (See BLS section of this handbook for details.)
Pediatric Cardiac Arrest Algorithm
Figure 16
CPR Quality
- Rate of 100 to 120 compressions per minute
- Compression depth: one-third diameter of chest (1.5 inches in infants (4 cm) and 2 inches in children (5 cm))
- Minimize interruptions
- Do not over ventilate
- Rotate compressor every two minutes
- If no advanced airway, 30:2 compression ventilation ratio for one provider and 15:2 compression ventilation ratio for two providers
- If advanced airway, 10 to 15 breaths per minute for one provider or 20 to 30 breaths per minute for two providers with continuous chest compressions
Shock Energy
- First shock: 2 J/kg
- Second shock: 4 J/kg
- Subsequent shocks: ≥ 4 J/kg
- Maximum dose of the shock: 10 J/kg or adult dose
Return of Spontaneous Circulation
- Return of pulse and blood pressure
- Spontaneous arterial pressure waves with intra-arterial monitoring
Advanced Airway
- Supraglottic advanced airway or ET intubation
- Waveform capnography to confirm and monitor ET tube placement
- Once advanced airway in place, give one breath every 2 to 3 seconds (20 to 30 breaths per minute)
Drug Therapy
- Epinephrine IV/IO dose: 0.01 mg/kg (Repeat every 3 to 5 minutes; if no IO/IV access, may give an endotracheal dose of 0.1 mg/kg.)
- Amiodarone IV/IO dose: 5 mg/kg bolus during cardiac arrest (May repeat up to two times for refractory VF/pulseless VT.)
Reversible Causes
- Hypovolemia
- Hypoxia
- H+ (acidosis)
- Hypothermia
- Hypo-/hyperkalemia
- Hypoglycemia
- Tamponade, cardiac
- Toxins
- Tension pneumothorax
- Thrombosis, pulmonary
- Thrombosis, coronary
- Trauma