Responding to Cardiac Arrest

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

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