Pediatric Cardiac Arrest Algorithm

AHA 2015 Update

Pediatric Cardiac Arrest Algorithm—2015 Update

1
CPR QUALITY
Start CPR ƒƒ Push hard (≥⅓ of anteroposterior
• Give oxygen diameter of chest) and fast (100-
• Attach monitor/defibrillator 120/min) and allow complete chest
recoil.
ƒƒ Minimize interruptions in compres-
sions.
ƒƒ Avoid excessive ventilation.
Yes Rhythm No ƒƒ Rotate compressor every 2 minutes,
2 shockable?
or sooner if fatigued.
ƒƒ If no advanced airway,
15:2 compression-ventilation ratio.
VF/pVT 9 Asystole/PEA
SHOCK ENERGY
FOR DEFIBRILLATION
3
ƒƒ First shock 2 J/kg
Shock ƒƒ Second shock 4 J/kg
4 ƒƒ Subsequent shocks ≥4 J/kg,
maximum 10 J/kg or adult dose

CPR 2 min DRUG THERAPY

• IO/IV access
ƒƒ Epinephrine IO/IV 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
Rhythm No endotracheal dose: 0.1 mg/kg (0.1
shockable? mL/kg of 1:1000 concentration).
ƒƒ Amiodarone IO/IV dose:
Yes -- 5 mg/kg bolus during cardiac ar-
rest. May repeat up to 2 times for
5 refractory VF/pulseless VT.
Shock ƒƒ Lidocaine IO/IV dose:
-- Initial: 1 mg/kg loading dose.
6 10
-- Maintenance: 20-50 mcg/kg per
minute infusion (repeat bolus

CPR 2 min CPR 2 min dose if infusion initiated >15 min-

utes after initial bolus therapy).
• Epinephrine every 3-5 min • IO/IV access
• Consider advanced airway • Epinephrine every 3-5 min
• Consider advanced airway
ADVANCED AIRWAY
ƒƒ Endotracheal intubation or supra-
glottic advanced airway
ƒƒ Waveform capnography or capnom-
etry to confirm and monitor ET tube
No Yes placement
Rhythm Rhythm
ƒƒ Once advanced airway in place,
shockable? shockable? give 1 breath every 6 seconds (10
breaths/min) with continuous chest
compressions
Yes
7 RETURN OF
Shock No
SPONTANEOUS
8 11 CIRCULATION
(ROSC)
CPR 2 min CPR 2 min ƒƒ Pulse and blood pressure
• Amiodarone or lidocaine • Treat reversible causes ƒƒ Spontaneous arterial pressure
• Treat reversible causes waves with intra-arterial monitoring

REVERSIBLE
CAUSES
ƒƒ Hypovolemia
No Yes
Rhythm ƒƒ Hypoxia
shockable? ƒƒ Hydrogen ion (acidosis)
ƒƒ Hypo-/hyperkalemia
12
ƒƒ Hypothermia
ƒƒ Tension pneumothorax
• Asystole/PEA 10 or 11 Go to 5 or 7 ƒƒ Tamponade, cardiac
• Organized rhythm check pulse ƒƒ Toxins
• Pulse present (ROSC) ƒƒ Thrombosis, pulmonary
© 2015 American post–cardiac arrest care ƒƒ Thrombosis, coronary
Heart Association

©2016 Physio-Control, Inc. 1.800.442.1142 www.physio-control.com Reprinted with permission

CL7178-00 2015 American Heart Association
Pediatric Tachycardia with a Pulse and Poor Perfusion Algorithm
AHA 2015 Update

Pediatric Tachycardia With a Pulse and Poor Perfusion Algorithm

SYNCHRONIZED
Identify and treat underlying cause
• Maintain patent airway; assist breathing as necessary
CARDIOVERSION
• Oxygen ƒƒ Begin with 0.5-1 J/kg;
• Cardiac monitor to identify rhythm; monitor blood pressure and oximetry ƒƒ if not effective, increase to 2 J/kg.
• IO/IV access ƒƒ Sedate if needed, but don’t delay
• 12-Lead ECG if available; don’t delay therapy cardioversion.

Narrow Wide
(≤0.09 sec) (>0.09 sec)
DRUG THERAPY
Evaluate
ƒƒ Adenosine IO/IV dose:
QRS duration
-- First dose:
1.1 mg/kg rapid bolus
Evaluate rhythm (maximum: 6 mg).
with 12-lead ECG -- Second dose:
or monitor 1.2 mg/kg rapid bolus
(maximum second dose: 12 mg).
ƒƒ Amiodarone IO/IV dose:
Probable Probable Possible -- 5 mg/kg over 20-60 minutes
ventricular or
sinus supraventricular
tachycardia tachycardia tachycardia ƒƒ Procainamide IO/IV dose:
• Compatible • Compatible history -- 15 mg/kg over 30-60 minutes
history (vague, nonspecific); -- Do not routinely administer
consistent with history of abrupt amiodarone and procainamide
together.
known cause rate changes
• P waves • P waves absent/
present/normal abnormal
• Variable R-R; • HR not variable
constant PR
• Infants: • Infants: rate usually
rate usually ≥220/min
<220/min
• Children: rate • Children: rate usually
usually <180/min ≥180/min Cardiopulmonary
compromise?
• Hypotension
• Acutely altered
mental status
• Signs of shock

Yes No

Search for Consider Synchronized Consider

and vagal cardioversion adenosine
treat cause maneuvers if rhythm regular
(No delays) and QRS
monomorphic

• If IO/IV access present, give adenosine Expert

or consultation
• If IO/IV access not available, or if adenosine advised
ineffective, synchronized cardioversion • Amiodarone
• Procainamide

© 2015 American Heart Association

©2016 Physio-Control, Inc. 1.800.442.1142 www.physio-control.com Reprinted with permission

CL7178-00 2015 American Heart Association