Cycle overview
- Shock → CPR 2 min → rhythm check
- After second shock: give epinephrine every 3–5 min; obtain IV/IO access
- After third shock: consider amiodarone or lidocaine
Start CPR
- Begin high-quality CPR immediately
- Provide bag-mask ventilation with oxygen
- Attach monitor/defibrillator as soon as available
Next: determine if the rhythm is shockable (VF/pVT) or nonshockable (asystole/PEA).
Shockable Path: Ventricular Fibrillation (VF) / Pulseless VT
Between shocks
- Perform uninterrupted compressions; switch compressors every 2 minutes
- Consider an advanced airway and continuous capnography
Nonshockable Path: Asystole / PEA
- Continue CPR for 2 minutes
- Obtain IV/IO access and give epinephrine every 3–5 minutes ASAP
- Consider advanced airway and capnography
- Treat reversible causes
Defibrillation Energy
| Shock Number | Energy (biphasic) | Referral |
|---|---|---|
| First shock | 2 J/kg | Defibrillation Basics |
| Second shock | 4 J/kg | AED/Manual Mode |
| Subsequent shocks | ≥4 J/kg (max 10 J/kg or adult dose) | PALS Overview |
Drug Therapy (IV/IO)
Epinephrine
- 0.01 mg/kg (0.1 mL/kg of 1:10,000) every 3–5 minutes
- Give ASAP for nonshockable rhythms; after 2nd shock for shockable
Antiarrhythmics (shock-refractory VF/pVT)
- Amiodarone 5 mg/kg IV/IO bolus; may repeat (max 3 total doses)
- Lidocaine 1 mg/kg initial IV/IO dose (if used instead of amiodarone)
Advanced Airway & CPR Quality
CPR Quality Targets
- Push hard (≥⅓ AP chest diameter) and fast (100–120/min)
- Allow full recoil; minimize interruptions (<10 s)
- Switch compressors every 2 minutes
Advanced Airway
- Consider ETT or supraglottic airway; confirm with capnography
- Once placed: ventilate 1 breath every 6 seconds (10/min) with continuous compressions
Reversible Causes: H’s & T’s
Systematically consider each H & T during every 2-minute CPR cycle.
Return of Spontaneous Circulation (ROSC) & Post–Cardiac Arrest Care
- If ROSC occurs → transition to post–cardiac arrest care
- If no ROSC after cycles and interventions, continue algorithm and reassess reversible causes
Cited Keywords & Referral Links
Each keyword links to the main website or a related post on gyathshammha.com.
Bottom line
Pediatric cardiac arrest management hinges on rapid high-quality CPR, early rhythm identification, timely shocks for VF/pVT, appropriate dosing of epinephrine and antiarrhythmics, airway optimization, and relentless search for reversible causes.
This guide is for education and does not replace clinical judgment or local protocols.