CARDIAC ARREST PEDIATRIC/ MEDICAL
ALL LEVELS
DESIGNATION OF CONDITION
Signs and symptoms include an unresponsive, apneic patient with absent brachial, femoral, or carotid pulses. If patient does not meet Termination of Resuscitation guidelines, continue with the following Treatment Guidelines.
EMPHASIS ON PATIENT CARE
1. Uninterrupted effective CPR using pit crew approach, if possible, defibrillation and ALS intervention as rapidly as possible
2. Patients in cardiac arrest should be initially managed in the field. Establish ventilation and circulation (compressions) as quickly as possible. Establish airway and vascular access rapidly. Consider first defibrillations and EPINEPHRINE (if indicated) before considering transport.
3. If the patient has a return of spontaneous circulation (ROSC) (sustained palpable pulses and measurable blood pressure), the patient should be transported to the closest appropriate facility. At the present time (2022) MMC has NICU and PICU capabilities.
4. All patients in cardiac arrest require immediate CPR, airway management and ventilations with oxygen. CPR and initial defibrillation take precedence over advanced airway management unless the airway cannot be managed with BLS maneuvers.
5. Defibrillation of the VF/ VT patient should occur as soon as possible
AEMT/PARAMEDIC
1. Establish IV/IO access and flush to confirm patency.
2. Administer Epinephrine, IV/IO
a. EPINEPHRINE (1:10,000) 0.01 mg./kg. IV/IO (0.1 ml./kg.) every 3-5 minutes throughout Cardiac Arrest as indicated
CARDIAC ARREST PEDIATRIC / MEDICAL
3. Be certain that early ventilations and effective compressions are being done. Ventilate at ratio of 15:2 for multiple rescuers. If LMA inserted ventilate at rate of every 2-3 seconds. Compress bag to raise chest only. Intubation limited to age 13 and older regardless of size or maturity of patient.
4. If indicated defibrillate early (V-fib and pulseless V-tach) 2 J/kg. initial. Subsequent shocks at 4 J/kg. increasing to maximum of 10 J/kg. or adult dose.
5. If indicated establish IV/IO and administer EPINEPHRINE early (Asystole and PEA) (1:10,000) 0.01 mg./kg. or 0.1 ml/kg. IV/IO. Repeat EPINEPHRINE every 3-5 minutes throughout resuscitation in all rhythms. Humeral IO preferred but other sites may be used as necessary.
6. Consider inserting LMA. Monitor ETCO2.
7. Consider staying at scene for first ten minutes of call, time to complete above interventions. Decision to transport a difficult one. Many parents/family members/bystanders are not accustomed to full resuscitation on-scene. In small children CPR can be safely and effectively performed in route. If unable to accomplish above interventions early consider transport for further level of care. Use your best judgement in deciding when to transport.
8. Follow the PALS pediatric cardiac arrest algorithm with rotation of compressor, adequate compressions, adequate ventilation, and medical and electrical interventions as indicated.
9. For refractory V-fib and V-tach consider AMIODARONE. 5 mg./kg. bolus. May repeat bolus two times every five minutes (three boluses total).
10. Consider all treatable causes of arrest (H’s and T’s).
TERMINATIION OF RESUSCITATION
1. Any patient who presents in cardiac arrest assumed to be from a medical cause will have CPR performed on scene for a minimum of 30 minutes if not transported after initial interventions. If ROSC is achieved at any time during resuscitation efforts the patient will be transported to the closest most appropriate hospital.
2. If after 30 Minutes the patient remains in Cardiac arrest, Medical Control should be contacted.
3. The following information should be collected if available, and relayed to medical control for further instructions:
The Patient’s:
• Age
• PMH
• General health (skin turgor, muscle tone, mobility of patient prior to arrest)
• Last time patient was seen alive
• Witnessed arrest
• Bystander CPR
• Pupillary Response
• Temperature
• Blood sugar
• Initial and current cardiac Rhythm
• Current ETCO2 reading
• Family wishes of resuscitation effort.
Resuscitation efforts may be terminated in the field if the patient meets the requirements for TOR guidelines, or with medical direction approval and if ALL of the following criteria are met:
a. CPR and ALS interventions have been attempted for at least 30 minutes,
b. No ROSC at any time during resuscitation efforts
c. The arrest is not the result of hypothermia
d. ETCO2 <15
e. Absence of Palpable Carotid/Femoral/Brachial pulses
f. Family is accepting of the decision to terminate efforts for resuscitation.
g. The patient does not have an LVAD in place
5. All patients with a LVAD (left ventricular assist device) in cardiac arrest should be transported unless there is an active DNR.
6. The patient may be transported prior to reaching the 30-minute benchmark if responders feel that staying on scene does not promote good patient care or exposes them to harm or there are other mitigating circumstances.
ALL LEVELS
DESIGNATION OF CONDITION
Signs and symptoms include an unresponsive, apneic patient with absent brachial, femoral, or carotid pulses. If patient does not meet Termination of Resuscitation guidelines, continue with the following Treatment Guidelines.
EMPHASIS ON PATIENT CARE
1. Uninterrupted effective CPR using pit crew approach, if possible, defibrillation and ALS intervention as rapidly as possible
2. Patients in cardiac arrest should be initially managed in the field. Establish ventilation and circulation (compressions) as quickly as possible. Establish airway and vascular access rapidly. Consider first defibrillations and EPINEPHRINE (if indicated) before considering transport.
3. If the patient has a return of spontaneous circulation (ROSC) (sustained palpable pulses and measurable blood pressure), the patient should be transported to the closest appropriate facility. At the present time (2022) MMC has NICU and PICU capabilities.
4. All patients in cardiac arrest require immediate CPR, airway management and ventilations with oxygen. CPR and initial defibrillation take precedence over advanced airway management unless the airway cannot be managed with BLS maneuvers.
5. Defibrillation of the VF/ VT patient should occur as soon as possible
AEMT/PARAMEDIC
1. Establish IV/IO access and flush to confirm patency.
2. Administer Epinephrine, IV/IO
a. EPINEPHRINE (1:10,000) 0.01 mg./kg. IV/IO (0.1 ml./kg.) every 3-5 minutes throughout Cardiac Arrest as indicated
CARDIAC ARREST PEDIATRIC / MEDICAL
3. Be certain that early ventilations and effective compressions are being done. Ventilate at ratio of 15:2 for multiple rescuers. If LMA inserted ventilate at rate of every 2-3 seconds. Compress bag to raise chest only. Intubation limited to age 13 and older regardless of size or maturity of patient.
4. If indicated defibrillate early (V-fib and pulseless V-tach) 2 J/kg. initial. Subsequent shocks at 4 J/kg. increasing to maximum of 10 J/kg. or adult dose.
5. If indicated establish IV/IO and administer EPINEPHRINE early (Asystole and PEA) (1:10,000) 0.01 mg./kg. or 0.1 ml/kg. IV/IO. Repeat EPINEPHRINE every 3-5 minutes throughout resuscitation in all rhythms. Humeral IO preferred but other sites may be used as necessary.
6. Consider inserting LMA. Monitor ETCO2.
7. Consider staying at scene for first ten minutes of call, time to complete above interventions. Decision to transport a difficult one. Many parents/family members/bystanders are not accustomed to full resuscitation on-scene. In small children CPR can be safely and effectively performed in route. If unable to accomplish above interventions early consider transport for further level of care. Use your best judgement in deciding when to transport.
8. Follow the PALS pediatric cardiac arrest algorithm with rotation of compressor, adequate compressions, adequate ventilation, and medical and electrical interventions as indicated.
9. For refractory V-fib and V-tach consider AMIODARONE. 5 mg./kg. bolus. May repeat bolus two times every five minutes (three boluses total).
10. Consider all treatable causes of arrest (H’s and T’s).
TERMINATIION OF RESUSCITATION
1. Any patient who presents in cardiac arrest assumed to be from a medical cause will have CPR performed on scene for a minimum of 30 minutes if not transported after initial interventions. If ROSC is achieved at any time during resuscitation efforts the patient will be transported to the closest most appropriate hospital.
2. If after 30 Minutes the patient remains in Cardiac arrest, Medical Control should be contacted.
3. The following information should be collected if available, and relayed to medical control for further instructions:
The Patient’s:
• Age
• PMH
• General health (skin turgor, muscle tone, mobility of patient prior to arrest)
• Last time patient was seen alive
• Witnessed arrest
• Bystander CPR
• Pupillary Response
• Temperature
• Blood sugar
• Initial and current cardiac Rhythm
• Current ETCO2 reading
• Family wishes of resuscitation effort.
Resuscitation efforts may be terminated in the field if the patient meets the requirements for TOR guidelines, or with medical direction approval and if ALL of the following criteria are met:
a. CPR and ALS interventions have been attempted for at least 30 minutes,
b. No ROSC at any time during resuscitation efforts
c. The arrest is not the result of hypothermia
d. ETCO2 <15
e. Absence of Palpable Carotid/Femoral/Brachial pulses
f. Family is accepting of the decision to terminate efforts for resuscitation.
g. The patient does not have an LVAD in place
5. All patients with a LVAD (left ventricular assist device) in cardiac arrest should be transported unless there is an active DNR.
6. The patient may be transported prior to reaching the 30-minute benchmark if responders feel that staying on scene does not promote good patient care or exposes them to harm or there are other mitigating circumstances.