- Conventional CPR should be given as most cardiac arrest in children is due to respiratory failure. However, if rescuers are unwilling/unable to give rescue breath, compression only CPR is better than no CPR.
- No excessive fluid during resuscitation
- No atropine for intubation (in 2010, atropine was recommended due to reports of paradoxical bradycardia during intubation).
- It is REASONABLE to give epinephrine (in 2010, epinephrine SHOULD be given in pulseless cardiac arrrest)
– Differ from adults: epinephrine should be given ASAP in non shockable rhythm
- Lidocaine and amiodarone maybe given for refractory VF
– Compared to amiodarone, lidocaine increases chance of ROSC but no difference between 2 drugs in survival to hospital discharge
– DIffer from adult: no recommendation about lidocaine use in adult refractory VF; lidocaine in adult is associated with increased mortality if given after MI; use of lidocaine is only suggested AFTER ROSC to prevent recurrence of VF
- Hypothermia is no better than normothermia in children; fever should be avoided
– In OHCA, it is reasonable to put the children in 5 days of normothermia; for IHCA, no evidence supporting hypothermia over normothermia
– Differ from adult: TTM has been shown to improve neurological outcome post ROSC in adults. A temperature range of 33 (hypothermia) to 36 (normothermia) has been recommended as the target temperature in TTM.
- Avoid hypotension and hypoxemia post-cardiac arrest.