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  • Primary cardiac arrest is rare in children. Early recognition and prompt treatment of respiratory distress and shock are essential to prevent the progression to cardiopulmonary arrest.
  • High-quality cardiopulmonary resuscitation (CPR) must be integrated into advanced life-support measures in order to ensure a good outcome during resuscitation. The code leader must therefore continually monitor the quality of chest compressions during the entire resuscitation.
  • When two or more health care providers are performing CPR in an infant or child the correct compression to ventilation ratio is 15:2 (15 compressions followed by 2 ventilations). In all other circumstances, the new universal 30:2 compression to ventilation ratio should be used.
  • Minimizing interruptions of chest compressions provides for better myocardial perfusion during CPR. Two-minute cycles of CPR should be performed before stopping compressions to reassess the child.
  • Automated external defibrillators can be safely and effectively used in children older than 1 year. If at all possible a pediatric attenuator device should be used if the automated external defibrillator is being used in a child younger than 8 years of age or less than 25 kg.
  • Overzealous ventilations via an advanced airway can impede venous return to the heart and thus potentially decrease cardiac output during CPR.
  • Ventricular fibrillation and pulseless ventricular tachycardia are now treated with single shocks followed immediately by 2-minute cycles of CPR in order to maintain myocardial perfusion after each defibrillation.
  • The use of length-based tapes are encouraged during resuscitations in order to more accurately calculate proper doses of medications and select the appropriate size equipment.
  • Intraosseous (IO) lines can be safely and effectively used in victims of any age. Anything that can be administered through an intravenous (IV) line can also be given via an IO line.
  • Medication administration via vascular access (IV or IO) is highly preferred over endotracheal administration because of an unreliable absorption of medications via the endotracheal route.
  • High-dose epinephrine is no longer routinely recommended in the Pediatric Advanced Life Support guidelines.
  • Always remember to consider the possibility of paroxysmal supraventricular tachycardiain any infant who presents with lethargy, fussiness, poor feeding, pallor, tachypnea, or shock.
  • The key to treating a child with pulseless electrical activity (PEA) is to quickly search for and correct any reversible causes. The most common cause of PEA in children is hypovolemia so always consider a rapid fluid bolus in any child presenting in a PEA rhythm.


The primary etiology of cardiopulmonary arrest in children differs from that in adult patients. Sudden cardiac arrest because of a primary cardiac dysrhythmia is rare in children.1 Unrecognized respiratory distress and shock are the most common etiologies of cardiopulmonary arrest in children. Once cardiopulmonary arrest has occurred in an out-of-hospital setting, the outcome generally remains poor with only 5% to 12% of children surviving to hospital discharge. The survival rate for children who experience cardiopulmonary arrest in an in-hospital setting has a slightly better survival rate to discharge of approximately 27%.2 Therefore, early recognition of a child in ...

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