Pediatric Advance Life Support: Pulseless Electrical Activity (PEA)

Assess ABCs- Primary Survey

·         Assess responsiveness and pulse

·         Active EMS system

·         Call for defibrillator/monitor

Note:  If a rhythm is present on the monitor but the pulse is absent (eg,PEA), CPR should be started immediately, beginning with chest compressions, and should continue for 2 minutes before the rhythm check is repeated.

Listen for Pulse Using Doppler

·         A doppler will help distinguish between a pulseless state and profoundly weak cardiac contractions with a low cardiac output (pseudo-PEA).

·         True PEA:  no pulse and no perfusion

·         Pseudo-PEA: weak pulse detected by doppler or echocardiography and severely compromised perfusion

Initiate CPR

·         Adequate compression rate (at least 100 compressions/min)

·         Adequate compression depth (at least one third of the AP diameter of the chest or approximately

·         1 1⁄2 inches [4 cm] in infants and approximately 2inches [5 cm] in children)

·         Allowing complete recoil of the chest after each compression

·         Minimizing interruptions in compression

·         Avoiding excessive ventilation

Secondary Survey

·         Intubate

·         Oxygenate

·         IV access

·         Treat reversible causes

Note: Once the patient is intubated, continue CPR with asynchronous ventilations and chest compressions.

Formula for Estimating Endotracheal tube size: 

Uncuffed ET tube:  mm ID = (age in years/4) + 4

Cuffed ET tube:  mm ID = (age in years/4) + 3

Confirm ET tube placement

n  Direct cord visualization

n  End-tidal CO2 monitor

n  Purple- problem

n  Yellow- yes

n  Tan- think about it

n  Bilateral breath sounds

n  CXR

n  Continuous waveform capnography

Note:  Continuous quantitative waveform capnography is now recommended for intubated patients throughout the periarrest period as a means of both confirming and monitoring correct placement of an endotracheal tube. 

Esophageal Detector Device (EDD)

·         May be considered in children weighing ≥ 20 kg with a perfusing rhythm

·         Insufficient data to recommend for or against its use in children during cardiac arrest

Verification of Endotracheal Tube Placement

·         Verify proper tube placement immediately after intubation

·         After securing the endotracheal tube

·         During transport

·         Each time the patient is moved (eg, from stretcher to bed)

DOPE Mnemonic

·         If an intubated patient’s condition deteriorates

·         Displacement of the tube

·         Obstruction of the tube

·         Pneumothorax

·         Equipment failure