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PALS — Pediatric Cardiac Arrest

Pediatric arrest is most often respiratory in origin. Highest-quality CPR + addressing airway/breathing precedes rhythm management. Asystole/PEA is the most common arrest rhythm in children.

Recognition

  • •Unresponsive + no normal breathing + no central pulse within 10 sec
  • •Bradycardia <60/min with poor perfusion = start CPR (peds-specific)
  • •Most pediatric arrest = hypoxic/asphyxial; address airway/breathing first

Steps

  1. 1
    Start CPR — 30:2 (single rescuer) or 15:2 (two rescuers, peds)
    Rate 100-120/min; depth ~1/3 AP chest (~1.5 in infant, ~2 in child).
  2. 2
    Attach defib pads + assess rhythm at 2-min cycle
  3. 3
    If shockable (VF/pVT) — defib 2 J/kg; subsequent 4 J/kg (max 10 J/kg or adult)
  4. 4
    If non-shockable (asystole/PEA) — continue CPR + epinephrine
  5. 5
    Epinephrine 0.01 mg/kg IV/IO q3-5 min
    Max 1 mg single dose. Give ASAP in non-shockable rhythms.
  6. 6
    Identify + treat reversible causes (H's & T's)
    Hypoxia + hypovolemia top of list in peds.
  7. 7
    Advanced airway when feasible — ETT or supraglottic
    Continuous compressions once advanced airway placed; ventilate 1 q2-3 sec.
  8. 8
    Post-ROSC: targeted temperature management 32-34°C × 24h, avoid hyperoxia + hyperthermia

Drugs + doses

DrugDoseNote
Epinephrine0.01 mg/kg IV/IO (0.1 mL/kg of 1:10,000)
Amiodarone5 mg/kg IV/IO bolus (refractory VF/pVT, may repeat ×2)
Lidocaine1 mg/kg IV/IO (alternative to amiodarone)
Magnesium sulfate25-50 mg/kg IV/IO for torsades (max 2g)
Atropine0.02 mg/kg (min 0.1 mg) for bradycardia from primary AV block

Pitfalls

  • !Do NOT use a defib energy >10 J/kg even if adult dose is lower.
  • !Bradycardia <60 with poor perfusion = CPR; do not wait for asystole.
  • !Avoid hyperventilation post-ROSC — worsens cerebral perfusion.
  • !Length-based tape (Broselow) for weight estimation if unknown.

Sources

  • AHA PALS 2020
  • Coté Pediatric Anesthesia 7e

Anatomy reference

Sourced reference images. 4 matches for "pediatric heart neonatal cardiac".

Heart_and_cardiac_blood_vessels,_1717._Wellcome_L0000338
Wikimedia · CC BY 4.0
Neonatal_Heart_Circulation
Wikimedia · CC BY 4.0
fig-ch10_07_01
OpenStax · CC BY 4.0
fig-ch20_01_06
OpenStax · CC BY 4.0
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Other crisis algorithms

Education only — not a substitute for facility protocols, MOC certification, or clinical judgment. Always follow your institutional crisis algorithm and confirm doses against current package inserts.