|Resuscitation - Basic life support
||In non-witnessed CA(cardiac arrest): the rescuer provides a brief period of CPR(cardiopulmonary resuscitation) before calling for professional help.
In witnessed sudden collapse: the “Call first” approach should be followed, where the rescuer calls for professional help followed by initiation of CPR.
Lone rescuer provides 30:2 compression–ventilation ratio for all age groups of patients. A Healthcare provider performing two-person CPR provides 15:2 compression–ventilation ratio for infants and children (of note, ratio of compression–ventilation is 3:1 for neonates).
Infant CPR: the two thumb encircling hands technique is preferred for two-rescuer CPR. For lone rescuer CPR the two-finger technique is recommended .
For child CPR, both one- and two-hand techniques can be used.
When performing CPR, lower third of the sternum should be compressed, and the compression depth should be one-third of the anterior–posterior diameter of the chest.
||The pediatric dose for manual defibrillation for ventricular fibrillation is 2 J/kg. If this is not successful, the subsequent dose should be 4 J/kg. In children above 8 years or above 25 kg automatic defibrillation can be performed with a standard automatic external defibrillator (AED) . In children who are age between 1 and 8 years, using of a pediatric-attenuated AED is preferable if available. ,,
||Jaw-thrust maneuver or chin-lift/head tilt maneuver can be done to make the airway patent if trauma is not suspected. Permanent airway can be established via endotracheal intubation or ventilation with a bag and valve mask (BVM). Which method to use depends on the time needed for transport and the experience of the health care provider. Cuffed endotracheal tubes are acceptable in the pediatric population and are safe even for children <8 years old, excluding neonates. Other advanced airways such as the laryngeal mask airway have not been studied in children with CA . After an advanced airway is placed, chest compressions and ventilation occur without interruption. Compressions should occur at a rate of 100/min and ventilations should take place at a rate of 8–10/min.,,
|Medication during CPR
||The IV or IO routes should be used for administering medications during CPR in the pediatric population. During CA recommended dose of epinephrine is 0.01 mg/kg of the 1:10,000 concentration. Subsequent IV doses of epinephrine are recommended every 3–5 min during resuscitation at the same dose. Due to the potential for worse neurologic outcome high-dose epinephrine is no longer recommended. ,,
||Temporary atrioventricular (AV) nodal conduction block and interruption of reentry circuits that involve the AV node is done by adenosine. Its short half-life cause wide safety margin. Adenosine should be given only IV or IO, and it should be followed by a rapid saline flush to promote drug delivery to the central circulation. When adenosine is given IV, it should be administered as close to the heart as possible. 
||Amiodarone causes slowing of AV conduction, prolonging of the AV refractory period and QT interval, and slowing of ventricular conduction (widens the QRS). Prior to administration expert consultation is strongly recommended.
Monitoring of blood pressure and electrocardiogram (ECG) during intravenous administration of amiodarone has to be done. If the patient has a perfusing rhythm, administer the drug slowly (over 20 to 60 minutes); if the patient is in VF/pulseless VT, give the drug as a rapid bolus. Through its vasodilatory property amiodarone causes hypotension, and the severity is related to the infusion rate. With the aqueous form of amiodarone hypotension is less common.
If there is prolongation of the QT interval or heart block the infusion rate has to be decreased. Infusion have to be stopped if the QRS widens to >50% of baseline or hypotension develops. Amiodarone also can cause bradycardia and torsades de pointes ventricular tachycardia. This drug should not be administered together with another drug that causes QT prolongation, as procainamide, without expert consultation.
||This is a parasympatholytic drug that accelerates sinus or atrial pacemakers and increases the speed of AV conduction. Due to its central effect small doses of atropine (<0.1 mg) may produce paradoxical bradycardia. In special circumstances such as organophosphate poisoning or exposure to nerve gas agents larger than recommended doses may be required. 
||Calcium administration is not recommended for pediatric cardiopulmonary arrest except in hyperkalemia (excess potassium), hypermagnesemia (excess magnesium), hypocalcemia (low calcium), or calcium channel blocker overdose.
If calcium administration is indicated either calcium chloride or calcium gluconate can be used. calcium chloride may be preferred in critically ill children, because it results in a greater increase in ionized calcium during the treatment of hypocalcemia. If the only venous access is peripheral, in the non arrest setting, calcium gluconate is recommended because it has a lower osmolality than calcium chloride and is therefore less irritating to the vein. 
||The alpha-adrenergic-mediated vasoconstriction of epinephrine increases aortic diastolic pressure and then coronary perfusion pressure, which is a critical determinant of successful resuscitation from cardiac arrest. Vasoconstrictive α-effects of the epinephrine predominate in the doses used during cardiac arrest.
Catecholamines and sodium bicarbonate should not administer simultaneously through an IV catheter or tubing because alkaline solutions such as the bicarbonate inactivate the catecholamines. 
||As infants have a relatively high glucose requirement and low glycogen stores, infants may develop hypoglycemia when energy requirements rise. Therefore checking blood glucose concentration during the resuscitation and treat hypoglycemia promptly. 
||Is used for the treatment of torsades de pointes or for documented hypomagnesemia.
Magnesium may cause hypotension if administered rapidly by causing vasodilation. 
||This prolongs the refractory period of the atria and ventricles and cause reduction in conduction velocity.
Procainamide should be infuse very slowly (over 30 to 60 minutes) while monitoring the ECG and blood pressure. Infusion rate has to be decreased if there is prolongation of the QT interval, or heart block; the infusion has to be stopped if the QRS widens to >50% of baseline or hypotension develops. Should not administer together with another drug causing QT prolongation.
Expert consultation is essential prior to using this drug for a hemodynamically stable patient.
||Routine administration is not recommended . May be administered for treatment of some toxidromes or special resuscitation situations such as hyperkalemic cardiac arrest.
||There are insufficient evidence in making a recommendation n favour or against the routine use of vasopressin during cardiac arrest. Pediatric and adult case series/reports suggested that vasopressin or its long-acting analog (terlipressin), can be effective in refractory cardiac arrest when standard therapy fails.