This Algorithm is based on the latest (2015) American Heart Association standards and guidelines.

PEDIATRIC CARDIAC ARREST ALGORITHM

START CPR

Give Oxygen Attach monitor / defibrillator

Shout for Help/Activate Emergency Response

CHECK RHYTHM. SHOCKABLE?

NO YES

SHOCK 1

VF/VT

CPR (2 Minutes)

Gain IV/IO Access

PEA / Asystole

CPR (2 Minutes) Gain IV/IO access

Epinephrine every 3-5 Min Decide: advanced airway

NO

YES

CHECK RHYTHM. SHOCKABLE?

Epinephrine: every 3-5 Min Decide: advanced airway

Amiodarone Look for and treat reversible causes

Look for and treat reversible causes

If Asystole/PEA, go to pathway B. If organized rhythm, check pulse

If ROSC, go to Post-Cardiac Arrest Care

NO

GO TO SHOCK 2 OR 3

YES

YES

NO

NO

YES

SHOCK 2

CPR (2 Minutes)

CHECK RHYTHM. SHOCKABLE?

SHOCK 3

CPR (2 Minutes)

CHECK RHYTHM. SHOCKABLE?

CPR (2 Minutes)

CHECK RHYTHM. SHOCKABLE?

CPR QUALITY • Push hard (≥ ½ of anterior-posterior diameter of chest) and fast (at

least (100/min) and allow complete chest recoil. • Minimize interruptions in compressions. • Avoid excessive ventilation. • Rotate compressor every 2 minutes • If no advanced airway, 15:2 compression-ventilation ratio.

o If advanced airway, 8-10 breaths/min with continuous chest compressions

SHOCK ENERGY FOR DEFIBRILLATION • First shock 2 J/kg, second shock 4 J/kg, subsequent shocks ≥4

J/kg, maximum 10 J/kg or adult dose

DRUG THERAPY • Epinephrine IV/IO Dose: 0.01 mg/kg (0.1 mL/kg of 1:10 000

concentration). Repeat every 3-5 minutes. If no IO/IV access, may give endotracheal dose: 0.1 mg/kg (0.1 mL/kg of 1:1000 concentration).

• Amiodarone IV/IO Dose: 5 mg/kg bolus during cardiac arrest. May repeat up to 2 times for refractory VF/pulseless VT.

ADVANCED AIRWAY • Endotracheal intubation or supraglottic advanced airway • Waveform capnography or capnometry to confirm and monitor ET tube

placement • Once advanced airway in place, give 1 breath every 6-8 seconds (8-10

breaths/min)

RETURN OF SPONTANEOUS CIRCULATION (ROSC) • Pulse and blood pressure • Spontaneous arterial pressure waves with intra-arterial

monitoring

REVERSIBLE CAUSES Hypovolemia Hypoxia Hydrogen ion (acidosis) Hypo-/hyperkalemia Hypothermia Hypoglycemia

Tension pneumothorax Tamponade (cardiac) Toxins Thrombosis (pulmonary) Thrombosis (coronary)

A B

Monitor for and treat agitation and seizures

Monitor for and treat hypoglycemia

Assess blood gas, serum electrolytes, calcium

If patient remains comatose after resuscitation from cardiac arrest,

consider therapeutic hypothermia (32°C-34°C)

Consider consultation and patient transport to tertiary care center

This Algorithm is based on the latest (2015) American Heart Association standards and guidelines.

OPTIMIZE VENTILATION AND

OXYGENATION

NOMOTENSIVE SHOCK

Titrate FIO2 to maintain oxyhemoglobin saturation 94%-99%; if possible, wean FIO2 if saturation is 100%

Consider advanced airway placement and waveform capnography

ASSESS FOR AND TREAT PERSISTENT

SHOCK

Identify, treat contributing factors*

Consider 20 mL/kg IV/IO boluses of isotonic crystalloid. Consider smaller boluses (eg. 10 mL/kg) if poor cardiac function suspected.

Hypovolemia Hypoxia Hydrogen ion (acidosis) Hypoglycemia Hypo-/hyperkalemia Hypothermia Tension pneumothorax Tamponade, cardiac Toxins Thrombosis, pulmonary Thrombosis, coronary Trauma

MANAGEMENT OF SHOCK AFTER ROSC ALGORITHM

*POSSIBLE CONTRIBUTING FACTORS

Consider the need for inotropic and/or vasopressor support for fluid-refractory shock.

Dobutamine

Dopamine

Epinephrine

HYPOTENSIVE SHOCK

Epinephrine

Dopamine

Norepinephrine Milrinone