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Introduction
  • The majority of cardiorespiratory arrests in infants and children are secondary to hypoxaemia and/or hypotension. However, it is important to recognise that Sudden Cardiac Arrest can also be seen in young people, due to dysrhythmias caused by underlying channelopathy, cardiomyopathy or myocarditis. Up to 25% of these cases have shockable rhythms.
  • This CPG refers to patients generally 3 hours old to 12 years of age.
  • Cardiac arrest is a time critical condition requiring immediate intervention. The ALS algorithm allows for a systematic approach to cardiac arrest and assumes basic life support (BLS) measures have been initiated and remain ongoing.
  • Respiratory arrest may occur alone, but if treated promptly may not progress to cardio-respiratory arrest.
  • Respiratory arrest with adequate cardiac output should be treated as per post resuscitation care.
Clinical Presentation
  • Bradycardia is an ominous sign in the infant / paediatric patient. If their pulse is <60bpm, they are unconscious AND display signs of poor perfusion, CPR is appropriate.
  • If circulation is restored, refer to Return of Spontaneous Circulation (ROSC) CPG.
  • Following a primary survey, resuscitation must be commenced on all patients in suspected cardiac arrest not meeting the criteria set out in the Determination of Death (TOR/ROLE) CPG, in line with Australian Resuscitation Council (ARC) guidelines.
Exclusion Criteria
Exclusion Criteria
Risk Assessment
  • If trauma is the cause, follow the Traumatic Cardiac Arrest CPG.
  • Consider early transportation for non-asystole patients as they will not meet the clinical criteria for termination of resuscitation efforts.
  • Ensure appropriate padding for neutral alignment to open the airway.
  • Effective airway control and adequate ventilation with oxygen supplementation are the keys to favourable outcomes in infants and children.
  • If vascular access is unobtainable, continue resuscitative efforts without medications
  • Calculations are based on weight in kilograms; use the Paediatric Drug Calculator
Management
Primary Care

Commence High Quality, Task Focused, Minimally Interrupted Chest Compressions.

  • Assess & defibrillate "shockable" rhythms every 2 minutes safely with a minimal peri-shock pause (follow prompts if using AED).
    • Shockable Rhythms: VF, Pulseless VT; 4 joules per kg.
    • Non-Shockable Rhythms: PEA, Asystole.
  • Clear airway and oxygenate patients early via controlled BVM ventilation as soon as practicable. Do NOT passively oxygenate children
  • Do not perform asynchronous ventilation
  • Work as a team, communicate well and establish a 'hands-off' overview position.
  • Apply CPR Feedback Device to monitor and correct CPR performance
    • Corpuls CPR Feedback Device: ≥ 6 years old or 20kg
    • Q-CPR Feedback Device: ≥ 8 years old or 25kg (Some AED's still have Q-CPR)
Intermediate Care (EMT / Level 2)
  • As per Primary Care guidelines
Advanced Care (AP)
  • Insert supraglottic airway devices
    • Once a supraglottic airway is in-situ (including i-gel), maintain a 15:2 or 30:2 regimen (this aids in situational awareness and control)
    • Asynchronous ventilation is not recommended in paediatric cardiac arrest
  • Obtain vascular access when possible to do so.
  • Adrenaline as per CPG after 2nd shock (or ASAP after IV access has been established) and thereafter every 2nd loop.
  • Amiodarone after a total of 3 shocks have been given (including AED shocks delivered prior to ambulance arrival).
  • Fluid therapy as per CPG for hypovolemic cardiac arrest
  • Glucose as per CPG in suspected hypoglycaemic cardiac arrest
Critical & Extended Care (CCP, PSO)
IMPACT CPR

The treatment for Cardiac Arrest patients revolves around core requirements; excellent quality chest compressions that are never interrupted unnecessarily, timely defibrillation and oxygenation.

Traditionally, these care needs have been approached in a regimental manner, and often some skills are prioritised at the expense and quality of others. Prioritising the core elements is essential and apply each of the other principles around that as necessary – as soon as it is possible to do so.

There is no prescribed order for this; it is dynamic and circumstance dependant as reflected in the Circular Diagram below.

Working space Good resuscitation cannot generally be delivered in poor environments. A rapid and dynamic risk assessment should be done to either create space or move the patient.
Standardised equipment placement The right equipment in the right place as often as possible.
High quality compressions Focused compressions (attention to quality) that are minimally interrupted. The use of CPR Quality Feedback Devices (where available) is mandatory.
Swap compressor EVERY 2 MINUTES A fatigued compressor delivers poor quality compressions. Prioritising paramedic skills over a swap of compressor in resource poor cases should not routinely occur unless it is critical to do so.
Create overview Scene leadership should be established as soon as practicable. This person should NOT be delivering skills, and ideally be standing away.
Maintain a calm, coordinated scene Encourage a calm and controlled scene with closed loop communication between the team, using functional language.
Ventilation The use of a BVM should be viewed as an important task in providing controlled ventilation. Aim for correct rate without excessive volumes under pressure.
Additional Information
  • Hypothermia in Western Australia as a cause of cardiac arrest is extremely rare and mostly accidental e.g. locked in a cool room. If you suspect that the cardiac arrest was secondary to hypothermia, the emphasis is on high performance CPR and transport.
  • ASMA available for advice.  
  • Refer to Determination of Death (TOR/ROLE)
References
References

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