Pediatric Cardiac Arrest Algorithm -- Advanced

Last updated: August 2, 2021

Version control: Our ACLS, PALS & BLS courses follow 2020 American Heart Association® Guidelines for CPR and ECC. American Heart Association® guidelines are updated every five years. If you are reading this page after December 2025, please contact support@acls.net for an update. Version 2021.01.c

When a child is in cardiac arrest begin CPR immediately. Push hard and fast at 100–120 beats per minute. Ventilate with a bag-mask and attach to supplemental oxygen. Two-person CPR for a child without a definitive airway will be at a ratio of 15 compressions to 2 breaths. Attach the monitor/defibrillator as soon as possible and check for shockable rhythm. If no shockable rhythm is detected (Asystole/PEA) obtain IV/IO access and give Epinephrine 0.01 mg/kg every 3–5 minutes. Consider an advanced airway and place the patient on a capnography monitor. Continue CPR and treat the reversible causes. If a shockable rhythm is detected defibrillate with a shock of 2 Joules/kg and resume CPR immediately after the shock. Obtain IV/IO access and give Epinephrine every 3–5 minutes. Consider an advanced airway and place the patient on a capnography monitor. This will depend on the skill of the provider and the availability of equipment. Continue CPR and check for a shockable rhythm every 2 minutes. Increase the Joules to 4 Joules/kg, increasing with every shock up to 10 Joules/kg or to an adult dose. Amiodarone IV/IO 5 mg/kg bolus of Lidocaine 1mg/kg can be given for VF or pulseless VT. Consider and treat the reversible causes.

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This page is written by on Jul 29, 2021.