Pediatric Pulseless Ventricular Tachycardia (VT) and Ventricular Fibrillation (VF)

Epinephrine

·         Epinephrine 0.01mg/kg (0.1ml/kg of a 1:10,100 solution) IV or IO

·         Epinephrine 0.1mg/kg (0.1ml/kg of a 1:1000 solution) via ET tube

·         May repeat dose every 3-5 minutes

·         After 5 cycles of CPR then defibrillate at 4J/kg

Note:  Vasopressin, which is frequently useful in adults, is not recommended for children experiencing ventricular fibrillation or pulseless ventricular tachycardia

Drug Therapy: Epinephrine

·         Increases systemic vascular resistance

·         Increases aortic root pressure

·         Increases coronary and cerebral perfusion during CPR

·         Escalating or high doses without demonstrable benefit

Sequence

·         Epinephrine should be administered during chest compressions

·         Prior to rhythm check, prepare to recharge the defibrillator (4 J/kg or more with a maximum dose not to exceed 10 J/kg or the adultdose, whichever is lower)

·         Check the rhythm

·         If the rhythm is “shockable,” deliver another shock

Defibrillation 2nd shock

Drug Therapy: Antiarrhythmics

·         Amiodarone

·         Lidocaine

Note:  When VF/pulseless VT persists after 2 to 3 shocks plus CPR and administration of a vasopressor, consider administering an antiarrhythmic such as Amiodarone.  If Amiodarone is unavailable, Lidocaine may be considered. Consider magnesium for torsades de pointes associated with a long QT interval. You should administer the drug during CPR, as soon as possible after rhythm analysis

Amiodarone

·         Dose: 5mg/kg rapid IV/IO

·         Repeat doses q5 min up to 15mg/kg

·         May produce vasodilation and hypotension

·         Continue CPR for 2 minutes then defibrillate at 4J/kg or more with a maximum dose not to exceed 10 J/kg or the adult dose, whichever is lower)

Note:  Amiodarone slows AV conduction, prolongs the AV refractory period and QT interval, and slows ventricular conduction (widens the QRS).

Defibrillation 3rd shock

Lidocaine

·         Dose 1mg/kg rapid IV/IO bolus

·         May be given via ET tube

·         Continue CPR for 2 minutes then defibrillate at 4J/kg

·         May be repeated 0.5-1.0 mg/kg 15 minutes after the initial dose

·         Total maximum dose of lidocaine is 3.0 mg/kg

·         Continue CPR for 2 minutes then defibrillate at 4J/kg or more with a maximum dose not to exceed 10 J/kg or the adult dose, whichever is lower)

Note:  If vascular access is not available and the child has been intubated, administer lidocaine through the tracheal tube at 2 to 3 times the intravenous dose, diluted with normal saline to a volume of 3 to 5 mL

Sequence

·         The antiarrhythmic should be administered during chest compressions

·         Prior to rhythm check, prepare to recharge the defibrillator (4 J/kg or more with a maximum dose not to exceed 10 J/kg or the adult dose, whichever is lower)

·         Check the rhythm

·         If the rhythm is “shockable,” deliver another shock

Note:  If defibrillation is successful but VF recurs, resume CPR and give another bolus of amiodarone before trying to defibrillate with the previously successful shock dose

Defibrillation 4th shock