Once VF or pulseless VT is identified
This is less common in paediatric practice but likely when there has been a witnessed and sudden collapse. It is commoner in the intensive care unit and cardiac ward
• Defibrillate the heart:
- give 1 shock of 4 per kilogram if using a manual defibrillator
- if using an AED for a child of 1-8 years, deliver a paediatricattenuated adult shock energy
- if using an AED for a child over 8 years, use the adult shock energy
- resume CPR:
- without reassessing the rhythm or feeling for a pulse, resume CPR immediately, starting with chest compression
- continue CPR for 2 min
- pause briefly to check the monitor:
- if still VF/VT, give a second shock at 4 J per kg if using a manual defibrillator, OR the adult shock energy for a child over 8 years using an AED, OR a paediatric-attenuated adult shock energy for a child between 1 year and 8 years
- resume CPR immediately after the second shock
- consider and correct reversible causes (see above: 4Hs and 4Ts)
- hypoxia
- hypovolaemia
- hyper/hypokalaemia (electrolyte disturbances)
- hypothermia
- tension pneumothorax
- tamponade
- toxic/therapeutic disturbance
- thromboembolism
- continue CPR for 2 min.
- pause briefly to check the monitor:
- if still VF/VT:
- give adrenaline 10 microgram per kg followed immediately by a (3rd) shock
- resume CPR immediately and continue for 2 min
- pause briefly to check the monitor
- if still VF/VT:
- give an intravenous bolus of amiodarone 5 mg per kg and an immediate further (4th) shock
- continue giving shocks every 2 min, minimising the breaks in chest compression as much as possible
- give adrenaline immediately before every other shock (i.e. every 3-5 min) until return of spontaneous circulation (ROSC)
- Note: After each 2 min of uninterrupted CPR, pause briefly to assess the rhythm
- if still VF/VT:
- continue CPR with the shockable (VF/VT) sequence
- if asystole:
- continue CPR and switch to the non-shockable (asystole or pulseless electrical activity) sequence as above
- if organised electrical activity is seen, check for a pulse:
- if there is ROSC, continue post-resuscitation care
- if there is no pulse, and there are no other signs of a circulation, give adrenaline 10 microgram per kg and continue CPR as for the non-shockable sequence (see linked item)
Reference:
- Resuscitation Council (UK). Advanced Paediatric Life Support. Guidelines 2005.