Pediatrics

Cardiac Arrest

Diagnosis

No pulse or HR < 60 beats per minute with poor perfusion despite effective ventilation with oxygen

Diagnosis

No pulse or HR < 60 beats per minute with poor perfusion despite effective ventilation with oxygen

  1. Initial Actions

    If no pulse or HR < 60 beats per minute with poor perfusion despite effective ventilation with oxygen

  2. Increase O2 to 100%. Turn off all anesthetic gases and anesthetic infusions

  3. Notify surgeon, call for help and code cart/defibrillator

  4. If ETT, 100-120 chest compressions/min + 20-30 breaths/min; avoid hyperventilation

  5. If no ETT, 15:2 compression:ventilation ratio (100-120 chest compressions/min)

  6. For chest compressions, ensure EtCO2 > 10 mmHg (go to CHEST COMPRESSIONS: SUPINE/PRONE)

    • Switch compressor every 2 min
    • Use sudden increase in EtCO2 for ROSC, Do NOT stop compressions for pulse check

  7. Obtain defibrillator. Attach pads. If VF/VT, shock 2 joules/kg. Continue chest compressions for 2 minutes

  8. Start timer. Designate team leader. Assign roles. Designate a scribe/recorder. Notify family

  9. Consider DDx

  10. Continue with Follow-on Actions

  11. Follow-on Actions

    Repeat sequence below until return of spontaneous circulation:

    If still in VF/VT, shock 4 joules/kg q2 min (up to 10 joules/kg on subsequent shocks)

  12. Resume chest compressions immediately regardless of rhythm

  13. Epinephrine 10 MICROgrams/kg IV q 3-5 min while in arrest (MAX 1 mg)

    • If still no ROSC after second dose of EPINEPHrine, activate ECMO
    • 10 MICROgrams/kg IV q 3-5 min, MAX 1 mg

  14. Check pulse & rhythm q 2 min during compressor change

  15. Check for reversible causes (Hs and Ts) early and often (see DDX)

  16. Lidocaine 1 mg/kg bolus (MAX 100 mg); may repeat (total: 2 doses) OR amiodarone 5 mg/kg bolus; may repeat (total: 3 doses)

    • 1 mg/kg IV/IO MAX 100 mg
    • 5 mg/kg IV/IO MAX 300 mg

  17. Repeat sequence in this box until return of spontaneous circulation

Patient weight

Between 0.5 kg and 120 kg

Reset the checklist?

Checked steps, the timer and this crisis log are cleared. The patient’s weight is kept.

Finish the crisis?

The timer pauses, and you can review the case and the event log.