Pediatric Cardiac Arrest Algorithm—2015 Update
1 CPR Quality
Start CPR • Push
hard (≥⅓ of anteroposterior
diameter of chest) and fast
• Give oxygen
(100-120/min) and allow complete
• Attach monitor/defibrillator chest recoil.
• Minimize interruptions in
compressions.
• Avoid excessive ventilation.
Yes Rhythm No • Rotate compressor every
2 2 minutes, or sooner if fatigued.
shockable? • If no advanced airway,
VF/pVT Asystole/PEA 15:2 compression-ventilation ratio.
9
Shock Energy for Defibrillation
3 First shock 2 J/kg, second shock
4 J/kg, subsequent shocks ≥4 J/kg,
Shock maximum 10 J/kg or adult dose
4
Drug Therapy
CPR 2 min
• Epinephrine IO/IV dose:
• IO/IV access 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 mL/kg of 1:1000
shockable? concentration).
• Amiodarone IO/IV dose:
Yes 5 mg/kg bolus during cardiac
5 arrest. May repeat up to 2 times
Shock for refractory VF/pulseless VT.
• Lidocaine IO/IV dose:
6 10 Initial: 1 mg/kg loading dose.
Maintenance: 20-50 mcg/kg per
CPR 2 min CPR 2 min minute infusion (repeat bolus dose
• Epinephrine
every 3-5 min • IO/IV access if infusion initiated >15 minutes
• Epinephrine every 3-5 min after initial bolus therapy).
• Consider advanced airway
• Consider advanced airway
Advanced Airway
• Endotracheal intubation or
supraglottic advanced airway
No Yes • Waveform capnography or
Rhythm Rhythm
capnometry to confirm and
shockable? shockable? monitor ET tube placement
• Once advanced airway in place,
Yes give 1 breath every 6 seconds
7 (10 breaths/min) with continuous
Shock No chest compressions
8 11 Return of Spontaneous
Circulation (ROSC)
CPR 2 min CPR 2 min • Pulse and blood pressure
• Amiodarone
or lidocaine • Treat reversible causes • Spontaneous arterial pressure
• Treat reversible causes waves with intra-arterial
monitoring
Reversible Causes
• Hypovolemia
No Yes
Rhythm • Hypoxia
shockable? • Hydrogen ion (acidosis)
• Hypoglycemia
12 • Hypo-/hyperkalemia
• Hypothermia
• Asystole/PEA ➞ 10 or 11 Go to 5 or 7 • Tension pneumothorax
• Organized rhythm ➞ check pulse • Tamponade, cardiac
• Pulse present (ROSC) ➞ • Toxins
© 2015 American post–cardiac arrest care • Thrombosis, pulmonary
Heart Association • Thrombosis, coronary
