Cardiac Arrest (Paediatric)
 
Cardiac Arrest of Child or Infant
For Newborn: See Newborn Recuscitation
   
Immediately commence CPR at:
30:2 if 1 rescuer (15:2 if 2 rescuers) at 100/min
See full Paed CPR details
If suspected severe hypothermia (i.e. cold water emersion)
               
Unconscious / Pulseless VF / VT   Pulseless Electrical Activity (PEA)   Asystole / Severe Bradydadia
Defibrillate Single shock
  4J/kg Biphasic/Monophasic		   Identify and Mx causes   Confirm rhythm on 3 leads and with printed ECG strip

Repeat Single shock
2 minutely if VF/VT persists
(not if T=<30c)

• Hypoxia
• Anaphylaxis
• Asthma
• Exsanguination
• Upper airway obstruction
• Tension pneumothorax

Commence CPR if any of:
- Pulseless
- HR < 40 (Children)
- HR < 60 (Infants)
               
VF/VT persists   PEA persists   Asystole / Severe Bradydadia persists
IV access / Normal Saline TKVO   IV access / Normal Saline TKVO   IV access / Normal Saline TKVO
Adrenaline 10mcg/kg IV or IO (min. 100mcg)
- Repeat 3 minutely if no output
  (6 minutely if T=30-32˚C)
  (no repeats if T <30˚C)		   Adrenaline 10mcg/kg IV or IO (min. 100mcg)
- Repeat 3 minutely if no output
  (6 minutely if T=30-32˚C)
  (no repeats if T <30˚C)		   Adrenaline 10mcg/kg IV or IO (min. 100mcg)
- Repeat 3 minutely if no output
  (6 minutely if T=30-32˚C)
  (no repeats if T <30˚C)
               
VF/VT persists   PEA persists   Asystole / Severe Bradydadia persists
Intubate or insert LMA   Intubate or insert LMA   Intubate or insert LMA
Change CPR ratio to 15:1   Change CPR ratio to 15:1   Change CPR ratio to 15:1
If unable to obtain IV or I/O
- Adrenaline 100mcg/kg via ETT
  (6 minutely if T=30-32˚C)
  (no repeats if T <30˚C) 		  If unable to obtain IV or I/O
- Adrenaline 100mcg/kg via ETT
  (6 minutely if T=30-32˚C)
  (no repeats if T <30˚C) 		  If unable to obtain IV or I/O
- Adrenaline 100mcg/kg via ETT
  (6 minutely if T=30-32˚C)
  (no repeats if T <30˚C)
               
VF/VT persists   PEA persists      
Amiodarone 5mg/kg IV / IO   Normal Saline 20ml/kg IV / IO      
Stop            
Amiodarone is contraindicated in confirmed or suspected Tricyclic antidepressant medication OD            
               
VF/VT persists            
Repeat Amiodarone 5mg/kg IV IV (max. combined dose 450mg)
(not if T=<30˚C)		            
               
VF/VT persists   PEA persists   Asystole / Severe Bradydadia persists
After 15min Paramedic CPR   After 15min Paramedic CPR   After 15min Paramedic CPR
Sodium Bicarbonate 8.4% 1ml/kg IV / IO (unless T=<30˚C)   Sodium Bicarbonate 8.4% 1ml/kg IV / IO (unless T=<30˚C)   Sodium Bicarbonate 8.4% 1ml/kg IV / IO (unless T=<30˚C)
               
If dehydration suspected         Pulse present
Normal Saline 20ml/kg IV         Severe Bradycardia and Inadequate Perfusion
            Normal Saline 20ml/kg IV
               
ROSC   ROSC   ROSC
Treat as per ROSC Mx   Treat as per ROSC Mx   Treat as per ROSC Mx
 
Sodium Bicarbonate may be administered earlier in the algorithm if hyperkalaemia suspected or in cardiac arrest secondary to TCA overdose