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  • The code leader must ensure that high-quality basic cardiopulmonary resuscitation (CPR) be integrated into advanced life-support measures in order to ensure a good outcome during resuscitation.

  • Initiate chest compressions before ventilations in order to immediately provide blood flow to the heart and brain (2015 American Heart Association [AHA] C-A-B recommendations).

  • When two or more health care providers are performing CPR on an infant or child (without signs of puberty), the correct compression-to-ventilation ratio is 15:2 (15 compressions followed by 2 ventilations). In all other circumstances, the universal compression-to-ventilation ratio is 30:2.

  • Perform 2-minute cycles of uninterrupted CPR before stopping compressions to reassess the child.

  • Automated external defibrillators (AEDs) can be safely and effectively used in infants and children of all ages. If possible, use a pediatric attenuator device for children weighing less than 25 kg.

  • Ventricular fibrillation and pulseless ventricular tachycardia are treated with single shocks followed immediately by 2-minute cycles of CPR in order to maintain myocardial and brain perfusion after each defibrillation.

  • Length-based tapes facilitate medication dosing and device size selections.

  • Intraosseous (IO) lines can be used in any age pediatric patient for any medication that can be delivered via the intravenous (IV) route.

  • IV or IO medication administration is preferred over the endotracheal route.

  • Pulseless electrical activity (PEA) requires the identification and correction of reversible causes, the most common of which is hypovolemia. Therefore, always consider a rapid fluid bolus in any child presenting in a PEA rhythm.

  • The quality of chest compressions can be monitored with continuous monitoring of end-tidal CO2 (ETCO2). An ETCO2 less than 10 to 15 mmHg may indicate low cardiac output secondary to inadequate depth of chest compressions during CPR, whereas >10 to 15 mmHg suggests effective chest compressions during CPR. An abrupt rise in ETCO2 during chest compressions may suggest the return of spontaneous circulation (ROSC).

  • After ROSC, avoid the risk of hyperoxia reperfusion injury. Titrate the oxygen fraction of inspired oxygen (FiO2) administration to maintain oxygen saturations of 94% to 99%.

Sudden cardiac arrest due to a primary cardiac dysrhythmia is rare in children.1 Unrecognized and progressive respiratory distress and shock are the most common etiologies of cardiopulmonary arrest (CPA) in children. The outcome for out-of-hospital CPA is poor, with only 4% to 13% of children surviving to hospital discharge.2 The survival rate of in-hospital CPA is approximately 27% to 33%.2,3 Early recognition of a child in respiratory distress and/or compensated shock is essential to prevent the progression to CPA.


The 2015 AHA CPR and Pediatric Advanced Life Support (PALS) guidelines continue to emphasize the importance of immediate high-quality basic life support by lay rescuers and by health care providers. The major change regarding the sequence of actions for CPR in the previous 2010 AHA guidelines was ...

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