Pediatric Cardiac Arrest Algorithm

for Suspected or Confirmed COVID-19 Patients CPR Quality

Updated April 2020
• Push hard (≥⅓ of anteroposterior
A diameter of chest) and fast
(100-120/min) and allow complete
Don PPE chest recoil.
• Limit personnel • Minimize interruptions in
compressions.
1 • Avoid excessive ventilation.
• Change compressor every
Start CPR 2 minutes, or sooner if fatigued.
• Ventilate with oxygen using bag-mask device with filter • If no advanced airway,
and tight seal, if unavailable use nonbreathing face mask 15:2 compression-ventilation ratio.
• Attach monitor/defibrillator
Shock Energy for Defibrillation
• Prepare to intubate
First shock 2 J/kg, second shock
4 J/kg, subsequent shocks ≥4 J/kg,
Yes Rhythm No maximum 10 J/kg or adult dose
2 shockable? Advanced Airway
9
VF/pVT Asystole/PEA • Minimize closed-circuit
disconnection
• Use intubator with highest
3 likelihood of first pass success
• Consider video laryngoscopy
Shock • Prefer cuffed endotracheal tube
B if available
• Endotracheal intubation or
supraglottic advanced airway
Prioritize Intubation / Resume CPR • Waveform capnography or
• Pause chest compressions for intubation capnometry to confirm and
• If intubation delayed, consider supraglottic airway or bag-mask device monitor ET tube placement
with filter and tight seal • Once advanced airway in place,
• Connect to ventilator with filter when possible give 1 breath every 6 seconds
(10 breaths/min) with continuous
4 10 chest compressions

CPR 2 min CPR 2 min Drug Therapy

IO/IV access • IO/IV access • Epinephrine IO/IV dose:
• Epinephrine every 3-5 min 0.01 mg/kg (0.1 mL/kg of the
0.1 mg/mL concentration). Repeat
every 3-5 minutes.
Rhythm No Rhythm Yes • Amiodarone IO/IV dose:
shockable? shockable? 5 mg/kg bolus during cardiac arrest.
May repeat up to 2 times for refrac-
Yes tory VF/pulseless VT.
or
5 Lidocaine IO/IV dose:
Shock No Initial: 1 mg/kg loading dose.
Maintenance: 20-50 mcg/kg per
6 11 minute infusion (repeat bolus dose
if infusion initiated >15 minutes after
CPR 2 min CPR 2 min initial bolus therapy).
Epinephrine every 3-5 min Treat reversible causes
Return of Spontaneous Circulation
(ROSC)
No No Yes • Pulse and blood pressure
Rhythm Rhythm
• Spontaneous arterial pressure
shockable? shockable? waves with intra-arterial
monitoring
Yes
Reversible Causes
7
Shock • Hypovolemia
• Hypoxia
8 • Hydrogen ion (acidosis)
• Hypoglycemia
CPR 2 min • Hypo-/hyperkalemia
• Amiodarone or lidocaine • Hypothermia
• Treat reversible causes • Tension pneumothorax
• Tamponade, cardiac
• Toxins
12 • Thrombosis, pulmonary
• Thrombosis, coronary
• If no signs of return of spontaneous Go to 5 or 7
circulation (ROSC), go to 10 or 11
• If ROSC, go to Post–Cardiac Arrest Care

© 2020 American Heart Association