Basic Life Support Algorithms

Pediatric Cardiac Arrest Algorithm (Two or More Rescuers): Step by Step

1. 1

   Confirm that the scene is safe

2. 2

   Check responsiveness and call for help

   • Check responsiveness
   • Call for help
   • Rescuer 1: stay with the patient
   • Rescuer 2: activate the emergency response system (ERS) and bring an AED/defibrillator
3. 3

   Check pulse and breathing simultaneously

   Perform this check for no more than 10 seconds. Abnormal breathing means absent or ineffective breathing, including gasping.

   • Pulse felt, breathing normal: monitor the patient until advanced responders arrive
   • Pulse felt, breathing abnormal: begin rescue breathing
   • Pulse not felt, breathing abnormal: start CPR
4. 4

   Pulse felt, breathing abnormal: rescue breathing

   • Give 1 breath every 2-3 seconds (20-30 breaths/min)
   • Reassess the pulse every 2 minutes. If the heart rate is <60/min and perfusion remains poor even with adequate oxygenation and ventilation, start CPR
   • Activate the emergency response system (if not already done)
   • For suspected opioid overdose, give an opioid antagonist, such as naloxone
5. 5

   Pulse not felt, breathing abnormal: start CPR

   • If only one rescuer is present: begin high-quality CPR cycles immediately (30 chest compressions : 2 rescue breaths)
   • If a second rescuer returns: switch to 15:2 cycles (15 chest compressions : 2 rescue breaths)
   • Apply the AED/defibrillator as soon as it is available
   • For suspected opioid overdose, consider giving an opioid antagonist, such as naloxone
   • Infants: use the two-thumb encircling technique or the heel of one hand. Children: use one or two hands, depending on the child’s size
6. 6

   Check the rhythm when the AED/defibrillator is available

   Is the rhythm shockable?

   • Shockable: deliver 1 shock, then immediately resume high-quality CPR for 2 minutes (or until the AED/defibrillator prompts the next rhythm check)
   • Nonshockable: immediately resume high-quality CPR for 2 minutes (or until the AED/defibrillator prompts the next rhythm check)
   • Keep providing CPR until ALS providers take over or the patient shows movement