Synopsis
Recognise paediatric cardiorespiratory arrest, deliver effective ventilation and compressions without delay, distinguish shockable from non-shockable rhythms, use weight-based drugs and defibrillation safely, and organise post-resuscitation care around the cause, child and family.
- Check safety and responsiveness, call for emergency help early and assess breathing for no more than 10 seconds.
- Give five initial rescue breaths, then start compressions if there are no signs of life or if severe bradycardia with poor perfusion persists despite respiratory support.
- Use 15 compressions to 2 ventilations when trained in paediatric BLS; otherwise use 30:2 and follow the ambulance call handler.
- Compress at 100 to 120/min to at least one-third of the anteroposterior chest depth, about 4 cm in an infant and 5 cm in a child, with full recoil and minimal interruption.
- Attach an AED or manual defibrillator promptly; paediatric attenuation is preferred for smaller children when available, but absence of an attenuator must not prevent AED use.
- First-line rhythm decision is shockable ventricular fibrillation or pulseless VT versus non-shockable bradycardia with poor perfusion, PEA or asystole.
- For a shockable rhythm give 4 J/kg and resume CPR immediately for 2 minutes; minimise the pre-shock and post-shock pause.
- For a non-shockable rhythm give IV or IO adrenaline 10 micrograms/kg, maximum 1 mg, as soon as access is available and repeat every 3 to 5 minutes.
- After the third shock give adrenaline and amiodarone; continue two-minute cycles, rhythm checks and treatment of reversible causes.
- Use hypoxia, hypovolaemia, electrolyte and metabolic disorders, hypo- or hyperthermia, tension pneumothorax, tamponade, thrombosis and toxins as an active cause checklist.
- After return of spontaneous circulation, immediately stabilise oxygenation, ventilation, perfusion, glucose, temperature and seizures and identify the cause.
- Document times, cumulative energy and drugs, enable supported parental presence when safe, and arrange multidisciplinary neurological and family follow-up.
Key red flags
Gasping, irregular or absent breathing is not normal breathing and should not delay CPR while a prolonged pulse check is attempted.
A heart rate below 60/min with poor perfusion despite adequate oxygenation and ventilation is a compression trigger even when a pulse remains detectable.
Bradycardia, weak central pulses, hypotension, falling consciousness and loss of the capnography or arterial waveform are peri-arrest signs.
A witnessed sudden collapse during exercise, a shockable rhythm or a family history of premature sudden death raises concern for a primary electrical or structural cardiac cause.
Recurrent deterioration after return of spontaneous circulation suggests an untreated reversible cause, displaced airway, inadequate ventilation, shock or evolving post-cardiac-arrest syndrome.
An infant under 24 hours old is generally managed with the newborn algorithm; teams should use the algorithm they know while summoning appropriate expertise rather than withholding effective resuscitation.
Investigation priorities
Recognise unresponsiveness, abnormal breathing and absent signs of life without delaying CPR.
Separate shockable ventricular fibrillation or pulseless VT from non-shockable rhythms.
Management branches
The child is unresponsive and not breathing normally.
- Call emergency help using speakerphone and open the airway.
- Give five rescue breaths and confirm visible chest rise.
- Start high-quality compressions with 15:2 if paediatric-trained or 30:2 otherwise.
- Attach an AED as soon as available while minimising interruptions.