Last updated: June 27, 2023
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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