Manual Defibrillation: If ≥ 30 days of age but < 8 years of age deliver 1 shock every 2 minutes (1st shock at 2J/kg and next 3 shocks at 4J/kg).
If ≥8 years deliver 1 shock every 2 minutes as per BH/manufacturer program settings.
Epinephrine: If patient is ≥ 30 days of age but < 12 years of age administer epinephrine every 4 minutes at the following dosages:
- if via IV or IO or CVAD administer 1:10,000 at a dose 0.01mg/kg (minimum single dose is 0.1mg)
- if via ETT administer 1:1000 at a dose of 0.1mg/kg to a max of 2mg (minimum single dose is 1mg)
If patient is ≥ 12 years then administer epinephrine every 4 minutes at the following dosages:
- if via IV or IO or CVAD administer 1mg of 1:10,000
- if via ETT administer 2mg in the concentration set out by individual base hospital
Amiodarone: Amiodarone is to be used if patient is found to be in VF or pulseless VT. If patient is ≥ 30 days of age but < 12 years of age administer Amiodarone via IV or IO at 5mg/kg to a maximum of 300mg for the initial dose. After 4 minutes, administer a 2nd dose (5mg/kg to a maximum dose of 150mg).
If the patient is ≥ 12 years of age administer an initial dose of 300mg. After 5 minutes, administer a 2nd dose (150mg).
Lidocaine: If Amiodarone is not available and the patient is ≥ 30 days of age and has no known sensitivity or allergy to Lidocaine and they are in VF or pulseless VT administer Lidocaine as follows:
- If patient is ≥ 30 days of age but < 12 years of age and < 40kg administer via IV/IO 1mg/kg or via ETT 2mg/kg. After 4 min repeat the dose.
- If patient is ≥ 12 years of age administer via IV/IO/CVAD 1.5mg/kg or via ETT 3mg/kg. After 4 minutes repeat the dose.
Intubation: Consider intubation if the airway cannot be adequately managed with first OPA or supraglottic airway.
Mandatory Patch Point: Patch to BHP after 3rd round of Epinephrine or after 3 analyses. If the patch fails, transport after the 4th analyses.
- Push hard and fast (at least 5cm) and make sure to allow for complete recoil of the chest
- Minimize interruptions in chest compressions
- Change out person doing compressions every 2 minutes
- Compression: Ventilation ratio of 30:2 (continuous if intubated) Be aware of ROC study if applicable
- If PETCO2 is less than 10mmHg attempt to improve CPR
Return of Spontaneous Circulation (ROSC)
- Obtain pulse rate and blood pressure
- Abrupt and sustained increase to PETCO2 (greater than 40mmHg)
Energy for Defibrillation
- Biphasic: manufacturers recommendations are usually between 120J and 200J (second and subsequent shocks should be at least equivalent). Make sure to follow local protocols.
- Monophasic: 360J
- Epinephrine IV/IO: 1mg every 3 to 5 minutes
- Amiodarone: 1st dose 300mg bolus, 2nd dose 150mg
- Utilize least invasive and most appropriate means (OPA then Supraglottic then ETT if necessary)
- Ventilate at 8 to 10 breaths per minute
Reversible Causes of Arrest:
- Hypovolemia, Hypoxia, Hydrogen Ion (acidosis), Hypo/Hyperkalemia, Hyperthemia
- Tension pneuomothorax, Tamponade, Toxins, Thrombosis