Pediatric Cardiac Arrest Algorithm for Suspected or Confirmed COVID-19 Patients PDF

Pediatric Cardiac Arrest Algorithm for Suspected or Confirmed COVID-19 Patients CPR Quality Updated April 2020 Push hard (≥⅓ of a...

Pediatric Cardiac Arrest Algorithm for Suspected or Confirmed COVID-19 Patients CPR Quality Updated April 2020 Push hard (≥⅓ of anteroposterior A diameter of chest) and fast (100-120/min) and allow complete Don PPE chest recoil. Limit personnel Minimize interruptions in compressions. 1 Avoid excessive ventilation. Change compressor every Start CPR 2 minutes, or sooner if fatigued. Ventilate with oxygen using bag-mask device with filter If no advanced airway, and tight seal, if unavailable use nonbreathing face mask 15:2 compression-ventilation ratio. Attach monitor/defibrillator Shock Energy for Defibrillation Prepare to intubate First shock 2 J/kg, second shock 4 J/kg, subsequent shocks ≥4 J/kg, Yes Rhythm No maximum 10 J/kg or adult dose 2 shockable? Advanced Airway 9 VF/pVT Asystole/PEA Minimize closed-circuit disconnection Use intubator with highest 3 likelihood of first pass success Consider video laryngoscopy Shock Prefer cuffed endotracheal tube B if available Endotracheal intubation or supraglottic advanced airway Prioritize Intubation / Resume CPR Waveform capnography or Pause chest compressions for intubation capnometry to confirm and If intubation delayed, consider supraglottic airway or bag-mask device monitor ET tube placement with filter and tight seal Once advanced airway in place, Connect to ventilator with filter when possible give 1 breath every 6 seconds (10 breaths/min) with continuous 4 10 chest compressions CPR 2 min CPR 2 min Drug Therapy IO/IV access IO/IV access Epinephrine IO/IV dose: Epinephrine every 3-5 min 0.01 mg/kg (0.1 mL/kg of the 0.1 mg/mL concentration). Repeat every 3-5 minutes. Rhythm No Rhythm Yes Amiodarone IO/IV dose: shockable? shockable? 5 mg/kg bolus during cardiac arrest. May repeat up to 2 times for refrac- Yes tory VF/pulseless VT. or 5 Lidocaine IO/IV dose: Shock No Initial: 1 mg/kg loading dose. Maintenance: 20-50 mcg/kg per 6 11 minute infusion (repeat bolus dose if infusion initiated >15 minutes after CPR 2 min CPR 2 min initial bolus therapy). Epinephrine every 3-5 min Treat reversible causes Return of Spontaneous Circulation (ROSC) No No Yes Pulse and blood pressure Rhythm Rhythm Spontaneous arterial pressure shockable? shockable? waves with intra-arterial monitoring Yes Reversible Causes 7 Shock Hypovolemia Hypoxia 8 Hydrogen ion (acidosis) Hypoglycemia CPR 2 min Hypo-/hyperkalemia Amiodarone or lidocaine Hypothermia Treat reversible causes Tension pneumothorax Tamponade, cardiac Toxins 12 Thrombosis, pulmonary Thrombosis, coronary If no signs of return of spontaneous Go to 5 or 7 circulation (ROSC), go to 10 or 11 If ROSC, go to Post–Cardiac Arrest Care © 2020 American Heart Association