Professional Documents
Culture Documents
Resuscitation algorithms
Margarita Burmester
Royal Brompton Hospital, London, UK
Commence BLS
Oxygenate
Ventilate as appropriate
Observe
Support ABCs; give No Persistent symptomatic
oxygen if needed bradycardia?
Consider expert opinion
During CPR Yes
Ensure full chest recoil
Push hard and fast (100/min) Epinephrine (adrenaline)*
Minimize interruptions in chest IV/IO: 0.01 mg/kg max 1 mg
compressions (0.1 mL/kg) of 1:10 000
Secure airway if needed, confirm Endotracheal: 0.1 mg/kg
placement with end-tidal CO2 (0.1 mL/kg) of 1:1000
Give uninterrupted Repeat every 35 min
compressions when trachea
intubated (810 breaths/min )
Atropine
IV/IO: 0.02 mg/kg (min dose:
Treat possible causes
0.1 mg, max total dose for child:
Hypoxia
1 mg). May repeat 1
Hypovolemia
Endotracheal: 0.03 mg/kg
Hypo/hyperkalemia/metabolic
Hypothermia
Tension pneumothorax
Tamponade, cardiac Consider cardiac pacing
Toxins
Thromboembolism
Trauma If pulseless arrest develops go
to Pulseless arrest algorithm
*Give atropine rst if suspected increased vagal tone or primary AV (Adapted with permission from 2010 American Heart Association guidelines.
block. 2010 International Consensus on Cardiopulmonary Resuscitation and
ABCs, airway, breathing, circulation; BLS, basic life support; CPR, Emergency Cardiovascular Care Science with Treatment
cardiopulmonary resuscitation; HR, heart rate. Recommendations (COSTR).)
Pediatric Heart Disease: A Practical Guide, First Edition. Piers E. F. Daubeney, Michael L. Rigby, Koichiro Niwa, and Michael A. Gatzoulis.
2012 Blackwell Publishing Ltd. Published 2012 by Blackwell Publishing Ltd.
282
Resuscitation algorithms 283
No
Pulse present? Pulseless arrest protocol
Yes
Search for and treat cause Vagal maneuvers (if no delays) Wide complex tachycardia algorithm
*European Resuscitation Council (ERC) 2010 Guidelines recommend a (Adapted with permission from 2010 American Heart Association
further third adenosine dose at 0.3 mg/kg followed by a fourth adenosine guidelines. 2010 International Consensus on Cardiopulmonary
dose at 0.40.5 mg/kg (max 12 mg) prior to cardioversion. Resuscitation and Emergency Cardiovascular Care
ABCs, airway, breathing, circulation; HR, heart rate. Science with Treatment Recommendations (COSTR).)
284 Appendices
Pulse No
present Pulseless arrest algorithm
Yes
No Yes
Patient
shocked?
ABC, airway, breathing, circulation; SVT, supraventricular tachycardia; VT, ventricular tachycardia.
(Adapted with permission from 2010 American Heart Association guidelines. 2010 International Consensus on Cardiopulmonary Resuscitation and
Emergency Cardiovascular Care Science with Treatment Recommendations (COSTR).)
Resuscitation algorithms 285
Commence BLS
Oxygenate and ventilate
2 min CPR,
check monitor
*European Resuscitation Council (ERC) 2010 Guidelines recommend rst pulseless electrical activity; VF, ventricular brillation; VT, ventricular
shock to be 4 J/kg. tachycardia.
**ERC 2010 Guidelines recommend adrenaline immediately after third (Adapted with permission from 2010 American Heart Association
shock. guidelines. 2010 International Consensus on Cardiopulmonary
AED, automated external debrillator; BLS, basic life Resuscitation and Emergency Cardiovascular Care Science with Treatment
support; CPR, cardiopulmonary resuscitation; PEA, Recommendations (COSTR).)
286 Appendices
Cyanosis
persists?
No Cyanosis Yes
persists?
Site IV
*In UK may use metaraminol 0.01 mg/kg IV (continuous infusion at Cardiac Intensive Care. Philadelphia: Williams and Wilkins, 1998; Lieh-Lai
0.11 g/kg/min). M et al. Pediatric Acute Care, 2nd edn. Philadelphia: Williams and Wilkins,
BP, blood pressure; SVR, supraventricular rhythm. 2001.)
(Based on information from Park MK, The Pediatric Cardiology
Handbook, 3rd edn. Philadelphia: Mosby, 2003; Chang AC et al. Pediatric