The Basic Life Support Algorithm is an important tool for multi-rescuer teams to use when responding to a pediatric cardiac arrest. This algorithm outlines the steps that should be taken to provide the best possible care for a child in cardiac arrest. The algorithm begins with assessing the scene and determining if there are any signs of life, such as breathing or movement. If there are no signs of life, the rescuer should begin chest compressions.
The Basic Life Support algorithm outlines how to provide rescue breaths and how to use an automated external defibrillator (AED). It also provides guidance on when to switch between rescuers and how to manage any complications that may arise.
Ensure a Safe Scene
Same with the single-rescuer BLS algorithm, It's also important to make sure to assess whether the location is safe enough to perform CPR if multiple responders are on site for an emergency involving a child who has suffered a sudden cardiac event. You want to be able to safely administer CPR before beginning the assessment.
Check for responsiveness
To check if the pediatric patient is responsive, shake the shoulder and ask "Are you okay?" loudly. Look at the chest and torso for movement and normal breathing. If the victim is unresponsive, the first responder should remain within the victim and resumes the BLS sequence while the second responder activates the emergency response system and retrieves the AED or defibrillator. If there are more than two rescuers:
- Rescuer 1 (or more) will stay with the victim.
- Rescuer 2 will activate the Emergency Medical Services.
- Rescuer 3 will retrieve an AED.
Assess the Pediatric Patient and Check Pulse
The rescuers who stayed with the victim will check the patient for a carotid pulse for 5-10 seconds. While checking the pediatric patient's pulse, check if the patient has adequate breathing by observing the chest for not more than 10 seconds.
If the pediatric patient has normal breathing:
Monitor the child, maintain a patent airway, and place the child in recovery position.
If there is abnormal breathing, but there is a pulse: Begin rescue breathing.
- Provide 12 -20 rescue breaths per minute.
- Recheck pulse every 2 minutes.
- Use a barrier device if available.
If the child has no pulse and not breathing: Begin 5 cycles of CPR, starting with chest compressions.
If the child doesn't have a pulse and not breathing, Perform Cardiopulmonary Resuscitation, starting with chest compressions. (1 cycle is 15 chest compressions to 2 rescue breaths)
- One rescuer will do the chest compressions, and another will do the rescue breathing.
- The compression to ventilation ratio will be 15:2
- Chest compression rate: 100-120 per minute
- Compression Depth: 2 inches (1/3 the AP diameter of the chest)
- Provide at least 12 rescue breaths per minute.
- Rescuers should switch places every 2 minutes or 5 cycles of CPR.
- Chest recoil should be complete between compressions.
- You should continue cardiopulmonary Resuscitation until the return of spontaneous circulation (ROSC) or until the termination of efforts.
Arrival of Automated External Defibrillator
According to the American Heart Association chain of survival, early use of an Automated External Defibrillator is the most important intervention for cardiac arrest survival and should be done as soon as possible. The rescuer who retrieved the AED applies the AED and follows directions given by the device. The rescuers that stayed with the victim will continue to provide CPR until the defibrillator is ready. To utilize an Automated External Defibrillator:
1. Turn it on and follow the voice prompts.
2. Firmly place the adult pads on the patient's chest according to the pad image.
3. Allow the AED to analyze the rhythm.
- If it is not shockable, administer CPR for two minutes, then recheck the rhythm every two minutes and continue CPR until Advanced Life Support becomes available.
- If the shock is indicated, ensure that no one is touching the patient and shout, "Clear, I'm Clear, you're Clear!" before delivering the shock. Press the "shock" button once the rescuers and the surrounding crowd are clear of the patient and resume five cycles of CPR.
Shockable rhythms include Ventricular Tachycardia (V-tach) and Ventricular Fibrillation (V-fib).
4. Continue CPR until Advanced Life Support becomes available
Once the patient has regained consciousness, it is important to place them in the recovery position while waiting for the emergency response team. This will help keep their airway open and prevent any further choking or aspiration of vomit. To place an adult in the recovery position:
1. Kneel beside the patient and roll them onto their side, with their uppermost leg bent at the knee and hip.
2. Place one arm behind their back and the other arm across their chest.
3. Tilt their head back slightly to open the airway.
4. Make sure they are stable and cannot roll onto their back or stomach.
5. Monitor the patient's breathing and pulse until medical help arrives.
6. If the patient stops breathing or their pulse weakens, begin CPR again.