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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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