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Paediatric resuscitation (PALS)
Cardiac arrest in children is usually the end of respiratory failure or shock, so the common rhythm is asystole or PEA; high-quality compressions, ventilation and early adrenaline 0.01 mg/kg are the basis, and defibrillation at 2 then 4 J/kg is reserved for VF or pulseless VT.
Why it matters in the exam
Exam questions are numerical: compression-to-ventilation ratio 30:2 for a single rescuer and 15:2 for two rescuers, rate 100–120 per minute, depth one third of the chest diameter (about 4 cm in an infant and about 5 cm in a child). With an advanced airway, give one breath every 2–3 seconds without pausing compressions. Adrenaline 0.01 mg/kg IV or IO every 3–5 minutes, and in a non-shockable rhythm — as early as possible.
A second question is bradycardia: a child with a pulse under 60 with poor perfusion although oxygenation and ventilation are adequate starts compressions — this is "arrest on the way". A third is SVT: in an infant a rate of 220 or more and in a child 180 or more, without variability and without P waves; in a stable child start with a vagal manoeuvre (ice to the face), then adenosine 0.1 mg/kg (max 6 mg) and then 0.2 mg/kg (max 12 mg); in an unstable child — synchronised cardioversion at 0.5–1 J/kg first, rising to 2 J/kg.
It is important to recognise the seriously ill child before arrest: tachycardia is an early sign, and hypotension is a late sign. Definition of hypotension: systolic pressure below 70 mmHg at one month to one year, below 70 plus twice the age in years at 1–10 years, and below 90 from age 10. In VF refractory to shocks give amiodarone 5 mg/kg or lidocaine 1 mg/kg, and in every arrest look for reversible causes (hypoxia, hypovolaemia, acidosis, potassium, hypothermia, tension pneumothorax, tamponade, toxins, thrombosis).
Key points
- Arrest in a child is usually the end of respiratory failure or shock.
- 30:2 for a single rescuer, 15:2 for two; rate 100–120.
- Adrenaline 0.01 mg/kg every 3–5 minutes.
- VF or pulseless VT: 2 J/kg, then 4 J/kg.
- Hypotension at 1–10 years: systolic below 70 plus twice the age.
Summary table
| Situation | Definition | Action | Dose |
|---|---|---|---|
| Arrest — asystole or PEA | No pulse, non-shockable rhythm | Compressions and ventilation, early adrenaline | Adrenaline 0.01 mg/kg every 3–5 minutes (max 1 mg) |
| Arrest — VF or pulseless VT | Shockable rhythm | Shock, 2 minutes of compressions, another shock | 2 J/kg, then 4 J/kg (up to 10 J/kg); amiodarone 5 mg/kg |
| Bradycardia with poor perfusion | Heart rate below 60 despite oxygenation and ventilation | Compressions | Adrenaline 0.01 mg/kg; atropine 0.02 mg/kg for vagal tone |
| Stable SVT | Infant 220 or more, child 180 or more, no P waves | Vagal manoeuvre, adenosine | 0.1 mg/kg (max 6 mg), then 0.2 mg/kg (max 12 mg) |
| Unstable SVT | Poor perfusion, reduced consciousness | Synchronised cardioversion | 0.5–1 J/kg first, rising to 2 J/kg |
In the full version for subscribers
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Sources
- AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care — Pediatric Basic and Advanced Life Support, 2020 (with 2025 update) — Cardiac arrest, bradycardia and tachycardia algorithms
- ERC Guidelines — Paediatric Life Support, 2021 — Recognition of the seriously ill child and resuscitation
- Nelson Textbook of Pediatrics, 22nd edition (2024) — Cardiopulmonary Resuscitation
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.