Pediatric Cardiac Arrest
Unresponsive child, no pulse, not breathing normally
All Pathways
PediatricsEmergency
Pediatric Cardiac Arrest (PALS 2025)
Pediatric Cardiac Arrest (PALS 2025): Pediatric Cardiac Arrest → Start High-Quality CPR → Attach Monitor/Defibrillator + IV/IO Access → Rhythm Check: Sh...
Pathway Overview
12 steps
Algorithm Steps
12 total
01Start 02Action Start High-Quality CPR
Begin CPR immediately while preparing for rhythm analysis
- Push hard (≥1/3 AP diameter): Infants 4cm, Children 5cm
- Push fast: 100-120 compressions/min
- Allow complete chest recoil
- Minimize interruptions (<10 sec)
- Compression:ventilation ratio: 15:2 (2 rescuers), 30:2 (1 rescuer)
- If advanced airway: continuous compressions, 1 breath q2-3 sec
03Action Attach Monitor/Defibrillator + IV/IO Access
Attach pads in anterior-posterior or anterior-lateral position
- Use pediatric pads/dose attenuator for <25 kg if available
- Adult pads acceptable if pediatric not available
- Establish IV or IO access (IO preferred if IV not rapid)
04Decision Rhythm Check: Shockable?
Is the rhythm VF or pulseless VT?
05Action Defibrillation
Shock for VF/pVT
- First shock: 2 J/kg
- Subsequent shocks: 4 J/kg (max 10 J/kg or adult dose)
- Resume CPR immediately for 2 minutes after shock
- Minimize peri-shock pause
06Action Epinephrine (after 2nd shock)
Give epinephrine if VF/pVT persists after initial shock
- Epinephrine: 0.01 mg/kg IV/IO (max 1 mg)
- Repeat every 3-5 minutes
- Can give via ETT: 0.1 mg/kg if no IV/IO
07Action Antiarrhythmic for Refractory VF/pVT
Consider after 2-3 shocks
- Amiodarone: 5 mg/kg IV/IO bolus (max 300 mg)
- May repeat x2 for refractory VF/pVT
- OR Lidocaine: 1 mg/kg IV/IO (if amiodarone unavailable)
08Decision ROSC?
Check for return of spontaneous circulation every 2 minutes
09Outcome Post-Cardiac Arrest Care
ROSC achieved - initiate post-arrest care
- Optimize ventilation and oxygenation (SpO2 94-99%)
- Avoid hyperventilation
- Maintain BP with fluids/vasopressors
- Obtain 12-lead ECG
- Consider targeted temperature management
- Identify and treat underlying cause
- Transfer to PICU
10Action Continue Resuscitation
Continue CPR cycles, reassess rhythm every 2 minutes
- Continue CPR 2-min cycles
- Reassess rhythm after each cycle
- Consider reversible causes
- ETCO2 <10 mmHg after 20 min may indicate poor prognosis
- Consult team for duration of resuscitation
- Path rejoins step 04Shared downstream outcome
11Action Asystole/PEA Management
Non-shockable rhythm: Focus on CPR and epinephrine
- Continue high-quality CPR
- Epinephrine: 0.01 mg/kg IV/IO (max 1 mg) ASAP
- Repeat epinephrine every 3-5 minutes
- Identify and treat reversible causes (H's and T's)
12Warning Treat Reversible Causes (H's and T's)
Search for and treat underlying causes
- Hypovolemia - fluid bolus 20 mL/kg
- Hypoxia - ensure adequate ventilation/oxygenation
- Hydrogen ion (acidosis)
- Hypo/Hyperkalemia - check glucose
- Hypothermia
- Tension pneumothorax - needle decompression
- Tamponade (cardiac) - pericardiocentesis
- Toxins - consider specific antidotes
- Thrombosis (coronary/pulmonary)
- Path rejoins step 08Shared downstream outcome
Guideline Source
2025 AHA/AAP Guidelines for CPR and ECC - Pediatric Advanced Life Support
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Does not address neonatal resuscitation (use NRP)
- Assumes standard hospital resources available
- Weight-based dosing requires accurate weight estimation
- Does not cover post-arrest care in detail
Contraindicated Populations
neonates_under_28_days
Applicable Regions
USInternational
US: Follows AHA 2025 PALS guidelines
International: Aligned with ILCOR 2025 recommendations
Version 1Next review: 2030-01-01
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Related Resources
Frequently Asked Questions
What is the Pediatric Cardiac Arrest (PALS 2025)?
The Pediatric Cardiac Arrest (PALS 2025) is a emergency clinical algorithm for Pediatrics. It provides a structured decision tree to guide clinical decision-making, based on 2025 AHA/AAP Guidelines for CPR and ECC - Pediatric Advanced Life Support.
What guideline is the Pediatric Cardiac Arrest (PALS 2025) based on?
This algorithm is based on 2025 AHA/AAP Guidelines for CPR and ECC - Pediatric Advanced Life Support (DOI: 10.1161/CIR.0000000000001368).
What are the limitations of the Pediatric Cardiac Arrest (PALS 2025)?
Known limitations include: Does not address neonatal resuscitation (use NRP); Assumes standard hospital resources available; Weight-based dosing requires accurate weight estimation; Does not cover post-arrest care in detail. Individual patient factors may require deviation from these recommendations.
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