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

Magnesium

·         25-50mg/kg IV/IO

·         Maximum 2gm

·         Torsades de Pointes VT

·         Hypomagnesemia

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

Note:  Magnesium is indicated for the treatment of documented hypomagnesemia or for torsades de pointes (polymorphic VT associated with long QT interval). Magnesium produces vasodilation and may cause hypotension if administered rapidly.

Sodium Bicarbonate

·         Dose 1mEq/kg IV/IO

·         For prolonged arrest interval

·         Hyperkalemia

·         Tricyclic antidepressant overdose

Note:  Routine use of sodium bicarbonate during pulseless arrest is not recommended. After you have provided effective ventilation and chest compressions and administered epinephrine, you may consider sodium bicarbonate for prolonged cardiac arrest

Termination of Resuscitative Efforts

·         No reliable predictors of outcome to guide when to terminate resuscitative efforts in children

·         Witnessed collapse, bystander CPR, and a short interval from collapse to arrival of professionals improve the chances of a successful resuscitation

Post-resuscitation

·         Maintain normal ventilation

·         Monitor temperature

·         Manage post-ischemic myocardial dysfunction

·         Maintain normal glucose

Ethical concerns

Family presence during resuscitation

Designated staff member should be available to support and remain with family during resuscitation

Positive psychological effects    

Planning, staff acceptance

Sources

PALS Provider Manual. American Heart Association 7272 Greenville Ave. Dallas, Tx 75231

Kleinman ME, Chameides L, Schexnayder SM, Samson RA, Hazinski MF, Atkins DL, Berg MD, de Caen AR, Fink EL, Freid EB, Hickey RW, Marino BS, Nadkarni VM, Proctor LT, Qureshi FA, Sartorelli K, Topjian A, van der Jagt EW, Zaritsky AL. Part 14: pediatric advanced life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(suppl 3):S876–S908.