Pediatric Advanced Life Support Algorithms

Pediatric Post-Cardiac Arrest Care Algorithm: Step by Step

1. 1

   Return of spontaneous circulation (ROSC)

   Resuscitation continues after ROSC. Perform assessments and interventions in parallel whenever possible.

2. 2

   Stabilize after ROSC

   • Airway: assess the child’s ability to maintain and protect the airway. If an endotracheal tube is present, confirm and monitor placement with clinical assessment and waveform capnography. If a supraglottic airway is present, assess position and effective ventilation
   • Oxygenation and ventilation: continue support while obtaining reliable measurements. Target SpO₂ 94% to 99%, or the child’s usual appropriate saturation. Target PaCO₂ for the child’s condition, generally 35 to 45 mm Hg or the established baseline
   • Hemodynamics and perfusion: maintain systolic and mean arterial pressure above the 10th percentile for age and sex. Monitor rhythm, arterial pressure when resources are available, perfusion, lactate, and urine output. Use fluid and vasoactive support according to the child’s physiology
   • Glucose and electrolytes: monitor glucose levels and prevent hypoglycemia. Identify and correct clinically significant electrolyte imbalances
3. 3

   Identify and treat the arrest cause and complications

   • Review events before and during the arrest
   • Obtain cause-directed laboratory tests and imaging
   • Obtain a 12-lead ECG for a suspected cardiac cause or recurrent arrhythmia
   • Use echocardiography for suspected myocardial dysfunction or structural or obstructive disease
4. 4

   Assess neurologic status

   Account for sedation, neuromuscular blockade, temperature management, shock, and organ dysfunction.

5. 5

   Has neurologic status returned to baseline?

   • No or unsure: ongoing critical care plus neurologic care
   • Yes: ongoing pediatric critical care
6. 6

   Not at baseline: ongoing critical care plus neurologic care

   • Continue all pediatric critical-care targets and cause-directed treatment
   • If comatose, use a 5-day TTM strategy; continue serial neurologic assessment and EEG when available; treat seizures
   • Obtain EEG, imaging, and other tests as needed
   • Delay definitive prognostic conclusions until at least 72 hours after cardiac arrest. Use findings from multiple modalities and account for confounding factors
7. 7

   At baseline: ongoing pediatric critical care

   • Continue pediatric oxygenation, ventilation, blood-pressure, and cause-directed care
   • Repeat neurologic assessments and monitor for recurrent instability or secondary organ injury
   • Begin recovery planning
8. 8

   Recovery and follow-up

   Rehabilitation, first-year physical, cognitive, and emotional assessment, and family support.