What if you witness a child suddenly collapse and stop breathing? It’s a terrifying thought, but one that could happen when you least expect it. Pediatric cardiac arrest occurs when a child’s heart stops pumping effectively, which means blood and oxygen are no longer reaching the brain and other vital organs. Time is critical in this situation.
Unlike adults, where cardiac arrest is often due to heart disease, in children, it’s usually the result of something like severe breathing problems or shock. That’s why early recognition and action are so important. The faster you respond, with high-quality CPR and emergency interventions, the better the probabilities of survival.
The PALS algorithm is more than just a checklist of medical steps; it’s a thoughtful, structured approach that helps healthcare providers think clearly and act quickly in high-pressure situations. Whether you’re in the emergency room, in an ambulance, or standing beside a young patient.
Identifying pediatric cardiac arrest quickly can significantly impact results. Below are key signs to look for:
When handling pediatric cardiac arrest, several key considerations must be taken into account, including anatomical and physiological differences, team dynamics, and the importance of family support.
Let’s break down this algorithm step by step, so it will guide you through each part in a simple way.
01.
The very first thing you do is begin high-quality CPR right away. At the same time, you start bag-mask ventilation and provide oxygen to help oxygenate the blood. It’s also important to attach the monitor or defibrillator as soon as possible. Once everything’s in place, you check the rhythm. If it turns out to be shockable, like VF or pVT, you move on to Step 2. If it’s not shocking, you skip ahead to Step 9.
02.
Now that the monitor is on, you take a closer look at the rhythm. If it’s Ventricular Fibrillation (VF ) or Pulseless Ventricular Tachycardia (pVT), you know you’re dealing with a shockable rhythm. In that case, it’s time to move to Step 3. If it’s something else, you’ll handle it differently later.
03.
As soon as you confirm a shockable rhythm, you deliver a shock right away. This electrical therapy is critical; it gives the heart a chance to reset and hopefully return to a normal rhythm.
04.
After the shock, you go right back into CPR without delay. During these two minutes, you work on getting IV (Intravenous ) or IO (Intraosseous ) access so you're ready to administer medications. At the end of the cycle, you reassess the rhythm to determine if another shock is needed. If it is, you continue to Step 5. If it’s no longer shocking, you jump to Step 12.
05.
You take another look at the rhythm. If VF or pVT persists, you deliver another shock. It's all about giving the heart another chance to react while you keep up good chest compressions in between.
06.
CPR continues for another 2 minute cycle. During this time, you administer epinephrine every 3 to 5 minutes to help stimulate the heart. You also consider placing an advanced airway and using capnography to check the effectiveness of compressions and ventilation. After this cycle, you check the rhythm again to see if it’s shockable, and you head to Step 7. If not, you go back to Step 12.
07.
If the rhythm remains shockable, you deliver another shock. These repeated shocks are vital for improving the chance of defibrillation success. You keep going with the algorithm to stay ahead of the arrest.
08.
After the third shock, you immediately resume CPR for another 2 minutes. This time, you consider giving antiarrhythmic medicines like amiodarone or lidocaine. It's also crucial to evaluate for and treat any reversible causes, like hypoxia or tension pneumothorax. Once that’s done, you reassess the rhythm again if it’s still shockable, you go back to Step 5. If not, you continue to Step 12.
09.
If the rhythm is not shockable and shows asystole or PEA(Pulseless Electrical Activity ), you act fast by giving epinephrine right away. These rhythms don’t respond to shocks, so medication and continuous CPR are your best tools.
10.
CPR continues for another 2 minutes. During this time, you make sure you’ve established IV or IO access and keep giving epinephrine every 3 to 5 minutes. You also evaluate whether to insert an advanced airway and use capnography to monitor effectiveness. At the end of the cycle, you check the rhythm again—if it turns shockable, you go to Step 7. If not, you move to Step 11.
11.
You continue CPR for yet another 2 minutes cycle and take a closer look at any reversible causes that may be contributing to the arrest. At the end of this cycle, you reassess the rhythm again. If it becomes shocking, you go back to Step 7. If it remains non-shockable, you move to Step 12.
12.
Has the patient achieved Return of Spontaneous Circulation (ROSC)? If yes, you immediately begin post-cardiac arrest care. If not, you continue CPR and look back to Step 10 to repeat the cycle. This point is all about deciding whether to persist or shift your focus based on the patient’s response.
The Pediatric Cardiac Arrest Algorithm offers a structured approach for healthcare providers to respond effectively when a child experiences cardiac arrest. In these critical moments, it’s crucial to first ensure the scene is safe, call for help, and begin high-quality CPR. The algorithm emphasizes the importance of quick assessment, securing an airway, and delivering appropriate interventions based on the child’s age and underlying conditions. Whether your role is in a hospital, clinic, or community setting, understanding this algorithm can significantly improve outcomes. At Bayside CPR, we’re dedicated to equipping you with the skills and knowledge necessary to act confidently in emergencies. Ready to enhance your lifesaving abilities? Join us for our training session!
