The Basic Life Support Algorithm for Pediatric Cardiac Arrest victims is a set of guidelines designed to help single rescuers provide life-saving care to children who have suffered cardiac arrest. The BLS algorithm is based on the American Heart Association's 2015 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, and it provides step-by-step instructions for how to respond in the event of a pediatric cardiac arrest.
Ensure a Safe Scene
Ensuring a safe scene is an important first step in the Basic Life Support Algorithm for Pediatric Cardiac Arrest victims. Before you perform Cardiopulmonary Resuscitation, ensuring the environment is safe for both the rescuer and the patient is essential. This includes checking for hazardous materials or objects, ensuring that no bystanders could be injured by medical equipment, and ensuring that all necessary medical supplies are readily available.
Check for responsiveness
Checking for responsiveness is the next step in the BLS Pediatric Cardiac Arrest Algorithm. The rescuer should gently shake the patient and call out their name to check for any response.
- If collapse is un-witnessed: Perform 5 cycles of CPR, then call the emergency response team and bring an AED to the patient.
- If collapse is witnessed: Activate the emergency response team and bring an AED before performing CPR.
Assess the Pediatric Patient and Check Pulse
Check the pediatric patient for a carotid pulse for 5-10 seconds. While checking the pulse, simultaneously check the patient for absent or abnormal breathing (gasping) by observing the patient's chest for 5-10 seconds.
If the child is not breathing, but there is a pulse, then begin only rescue breathing:
- Provide 12-20 rescue breaths per minute.
- Recheck pulse every 2 minutes.
If the child has normal breathing: Continue to assess the child, maintain a patent airway, and place the child in recovery.
If the child has no pulse and not breathing: Begin 5 cycles of CPR, starting with chest compressions.
If the child is unconscious, has no pulse, and not breathing, perform Cardiopulmonary Resuscitation, starting with chest compressions (1 cycle is 30 chest compressions to 2 rescue breaths)
- Place one or both of your hands on the lower sternum of the child, between the nipples.
- The depth of compression is at least 1/3 the depth of the patient's chest or 2 inches.
- Provide 100-120 compressions per minute. This is 30 compressions every 15 to 18 seconds.
- Allow for full chest recoil with each compression.
- Allow for only minimal interruptions to chest compressions.
- Provide at least 6 rescue breaths per minute.
- Standard CPR with an advanced airway: 12-20 rescue breaths per minute.
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. 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 Fibrillation or Ventricular Tachycardia.
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.