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

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