Emergency Medicine

Paediatric Emergencies 341

CARDIOPULMONARY RESUSCITATION

Call

Resuscitation

Team

(1 min CPR

first, if alone)

During CPR:

●Ensure high-quality CPR: rate, depth, recoil

●Plan actions before interrupting CPR

●Give oxygen

●Vascular access (intravenous, intraosseous)

●Give adrenaline (epinephrine) every 3–5 min

●Consider advanced airway and

capnography

●Continuous chest compressions when

advanced airway in place

●Correct reversible causes

Reversible causes

●Hypoxia

●Hypovolaemia

●Hypo-/hyperkalaemia/metabolic

●Hypothermia

●Tension pneumothorax

●Toxins

●Tamponade – cardiac

●Thromboembolism

Unresponsive?

Not breathing or only

occasional gasps

CPR (5 initial breaths then 15:2)

Attach defibrillator/monitor

Minimize interruptions

Assess

rhythm

Non-shockable

(PEA/asystole)

Shockable

(VF/pulseless VT)

1 shock 4 J/kg

Immediately resume:

CPR for 2 min

Minimize interruptions

Immediately resume:

CPR for 2 min

Minimize interruptions

Immediate post-cardiac

arrest treatment

●Use ABCDE approach

●Controlled oxygenation

and ventilation

●Investigations

●Treat precipitating cause

●Temperature control

●Therapeutic hypothermia?

Return of spontaneous

circulation

Figure 11.2 Paediatric advanced life support algorithm. ABCDE, airway/breathing/
circulation/disability/exposure; CPR, cardiopulmonary resuscitation; ECG,
electrocardiogram; PEA, pulseless electrical activity; VF, ventricular fibrillation;
VT, ventricular tachycardia. Reproduced with kind permission from European
Resuscitation Council (2010) European Resuscitation Council Guidelines for
Resuscitation 2010. Section 1. Executive summary. Resuscitation 81 : 1219–76.