Regional Emergency Medical Advisory Committee of New York City Certified First Responder Support Protocols Copyright January 1996 (8/96)

353 PEDIATRIC NON-TRAUMATIC CARDIAC ARREST AND SEVERE BRADYCARDIA

For infants and children with non-traumatic cardiac arrest, and infants and children under 9 years of age with a heart rate less than 60 beats per minute (severe bradycardia) and signs of inadequate central (proximal) perfusion (decompensated shock):

Initiate Basic Cardiac Life Support procedures. (For infants, see guidelines below.)

Request Advanced Life Support assistance.

If the patient is 9 years of age or older, appropriately trained personnel are present, and a semi-automatic defibrillator is available, see Protocol #303.

Transport in accordance with first responder agency policy, keeping the child warm.

NOTE:

CARDIOPULMONARY RESUSCITATION IN AN INFANT IS PERFORMED UTILIZING CHEST COMPRESSIONS WITH INTERPOSED VENTILATIONS IN A RATIO OF 5:1 AT A RATE OF 120 (100 COMPRESSIONS, 20 VENTILATIONS) PER MINUTE.

IF THE INFANT HAS A HEART RATE LESS THAN 60 BEATS PER MINUTE:

• Assist ventilation at a rate of 20 breaths per minute.
• Start CPR if the heart rate is not rapidly increasing following 30 seconds of assisted ventilation.
• Stop CPR and resume assisted ventilation at a rate of 20 breaths per minute once the heart rate is greater than 60 beats per minute and rapidly increasing.
• Switch to high concentration mask or "blow by" oxygen once the heart rate is greater than 100 beats per minute, the respiratory rate is greater than 20 breaths per minute, and central cyanosis disappears.
  

IF THE INFANT OR CHILD HAS CARDIAC ARREST:

• Start CPR immediately.
• Stop CPR and begin assisted ventilation at a rate of 20 breaths per minute once the heart rate is greater than 60 beats per minute and rapidly increasing.
• Switch to high concentration mask or "blow by" oxygen once the heart rate is greater than 100 beats per minute, the respiratory rate is greater than 20 breaths per minute, and central cyanosis disappears.
  

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