1. High-quality cardiopulmonary resuscitation (CPR) is the foundation of pediatric advanced life support (PALS) resuscitation for health care professionals. We reaffirm the key components of high-quality CPR: providing adequate chest compression rate and depth, minimizing interruptions in CPR, allowing full chest recoil between compressions, and providing sufficient ventilation for the pediatric patient population while avoiding excessive ventilation.
2. For initial nonshockable rhythms, administering epinephrine as soon as possible is associated with favorable outcomes for infants and children in cardiac arrest.
3.
Rapid defibrillation remains the priority for cardiac arrest with initial shockable rhythms. Administer epinephrine if defibrillation is not immediately possible.
4.For infants and children with continuous invasive arterial blood pressure monitoring in place during CPR, diastolic blood pressure targets of ≥25 mm Hg in infants and ≥30 mm Hg in children at least 1 year of age are now included as hemodynamic goals of high-quality cardiopulmonary resuscitation.
5.End-tidal carbon dioxide (ETCO2) can be an indicator of CPR quality, although the use of specific ETCO2 cutoff values to guide termination of resuscitation in infants and children is not advised.
6.Preventing hyperthermia is a critical component of post–cardiac arrest care. Avoiding central temperatures >37.5 °C can improve neurological outcomes in infants and children who remain comatose following cardiac arrest.
7.For infants and children, new data support maintaining post–cardiac arrest systolic and mean arterial blood pressure greater than the 10th percentile for age and sex.
8.Neuroprognostication after cardiac arrest in infants and children requires multiple modalities be assessed at various timepoints throughout the post–cardiac arrest period. Single tests conducted in isolation carry a risk of inaccurately predicting neurologic outcomes.
9.After discharge from the hospital, cardiac arrest survivors often have ongoing physical, cognitive, and behavioral challenges and require evaluation for appropriate therapies and interventions.
10.New data support the use of IV sotalol as an anti-arrhythmic to treat infants and children with supraventricular tachycardia (SVT) and cardiopulmonary compromise that is unresponsive to vagal maneuvers, IV adenosine, and electrical synchronized cardioversion, when expert consultation is not available.
