Pediatric Basic and Advanced Life Support: ۲۰۲۰ AHA Algorithms Overview

Cardiac arrest in children is a critical emergency, often resulting from respiratory failure or shock, and requires immediate recognition and intervention to improve survival and neurological outcomes. Early initiation of high-quality cardiopulmonary resuscitation (CPR) and timely defibrillation, when indicated, are the cornerstones of effective resuscitation. The ۲۰۲۰ American Heart Association (AHA) pediatric algorithms emphasize a structured approach. Initial actions include ensuring scene safety, assessing responsiveness, and activating the emergency response system. Pulse and breathing should be evaluated simultaneously within ۱۰ seconds. If normal breathing and pulse are present, monitoring is continued. In cases of respiratory arrest with a pulse, rescue breathing (۱ breath every ۲-۳ seconds) is initiated with pulse reassessment every ۲ minutes. If no pulse is detected, or if heart rate is ۶۰/min with signs of poor perfusion, CPR must begin immediately. High-quality CPR includes compressions at a rate of ۱۰۰-۱۲۰/min and depth of at least one-third the chest diameter, with full chest recoil and minimal interruptions. A single rescuer uses a ۳۰:۲ compression-to-ventilation ratio, whereas two rescuers use ۱۵:۲. Early use of an AED or manual defibrillator is strongly recommended. For shockable rhythms (ventricular fibrillation or pulseless ventricular tachycardia), defibrillation is delivered (initially ۲ J/kg, followed by ۴ J/kg, up to ۱۰ J/kg maximum), with CPR resumed immediately after each shock. Epinephrine is administered every ۳-۵ minutes, and amiodarone or lidocaine may be considered for refractory VF/pulseless VT. Non-shockable rhythms (asystole/PEA) are managed with uninterrupted CPR, rapid IV/IO access, epinephrine every ۳-۵ minutes, and evaluation for reversible causes (e.g., hypovolemia, hypoxia, acidosis, hypothermia, toxins, thromboembolism). Resuscitation cycles continue until return of spontaneous circulation (ROSC) or advanced care is available. Post-cardiac arrest management focuses on optimizing oxygenation, perfusion, and neurological outcomes.