# Pediatric cardiac arrest

Follow the pediatric shockable and non-shockable pathways, with weight-based medication and early base contact.

Population: Pediatric. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: See the linked OCEMS source for revision and implementation dates..
Canonical page: https://www.ocmedic.com/guides/pediatric-cardiac-arrest/
Official source: [SO-P-040 — Cardiopulmonary Arrest - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2025-11/SO-P-40%20Cardiac%20Arrest%2011-25.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Key cautions & base contact

- Do not use adult medication doses or adult fixed-energy shocks for a child.
- The current pediatric arrest order does not include routine sodium bicarbonate; an I-20 preparation row alone does not establish an indication.

## Source documents

- [SO-P-040 — Cardiopulmonary Arrest - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2025-11/SO-P-40%20Cardiac%20Arrest%2011-25.pdf)

## Start resuscitation

- Begin or continue high-quality CPR and support ventilation with high-flow oxygen by BVM. Obtain the rhythm and defibrillator without unnecessary interruption.
- Make base contact as soon as possible; a pediatric-capable base is preferred. Establish IV/IO access while maintaining compressions.

## VF / pulseless VT

- Initial defibrillation: 2 J/kg biphasic, or the source-allowed programmed/manufacturer setting. Continue CPR for about 2 minutes.
- For persistent VF/pulseless VT, use 4 J/kg at the subsequent shock steps. Continue CPR between rhythm assessments and shocks.
- For continued VF/pulseless VT, epinephrine is 0.01 mg/kg IV/IO using 0.1 mg/mL, repeated approximately every 3 minutes.
- For persistent shockable arrest, amiodarone is 5 mg/kg IV/IO, with source-listed repeat doses at 5 and 10 minutes and a stated maximum of 450 mg. Alternative: lidocaine 1 mg/kg IV/IO, maximum 100 mg, once. Follow the full sequence and account for prior doses.

## PEA / asystole

- Continue CPR and ventilation, establish IV/IO, and give epinephrine 0.01 mg/kg of 0.1 mg/mL IV/IO approximately every 3–5 minutes.
- Look for reversible causes, including hypoxia, hypovolemia, glucose/electrolyte abnormalities, hypothermia, acidosis, tension pneumothorax, tamponade, toxins, or thrombosis.
- For a diabetic patient with suspected hypoglycemia, the arrest order lists D10 5 mL/kg IV/IO, maximum 250 mL. If VF/pulseless VT appears during this branch, follow its 4 J/kg transition step.

## ROSC or continuing arrest

- After a pulse returns, continue oxygenation and ventilation and correct hypoxia or hypovolemia. Contact base for destination and ALS transport. If base cannot be reached, the source directs transport to the nearest ERC.
- For continuing arrest, request further resuscitation orders and destination direction from base. Report weight, rhythm changes, shocks, medication totals/times, ETCO₂ when available, and any ROSC.