European Resuscitation Council Guidelines for Resuscitation 2010 ...

D. Biarent et al. / Resuscitation 81 (2010) 1364–1388 1379
charge. One paediatric case series demonstrates the effectiveness of
amiodarone for life-threatening ventricular arrhythmias. 287 Therefore,
IV amiodarone has a role in the treatment of defibrillation
refractory or recurrent VF/pulseless VT in children.
Extracorporeal life support
Extracorporeal life support should be considered for children
with cardiac arrest refractory to conventional CPR, if the arrest
occurs in a highly supervised environment and available expertise
and equipment to rapidly initiate extracorporeal life support
(ECLS).
Arrhythmias
Unstable arrhythmias
Check for signs of life and the central pulse of any child with an
arrhythmia; if signs of life are absent, treat as for cardiopulmonary
arrest. If the child has signs of life and a central pulse, evaluate
the haemodynamic status. Whenever the haemodynamic status is
compromised, the first steps are:
1. Open the airway.
2. Give oxygen and assist ventilation as necessary.
3. Attach ECG monitor or defibrillator and assess the cardiac
rhythm.
4. Evaluate if the rhythm is slow or fast for the child’s age.
5. Evaluate if the rhythm is regular or irregular.
6. Measure QRS complex (narrow complexes: 0.08 s).
7. The treatment options are dependent on the child’s haemodynamic
stability.
Bradycardia
Bradycardia is caused commonly by hypoxia, acidosis and/or
severe hypotension; it may progress to cardiopulmonary arrest.
Give 100% oxygen, and positive pressure ventilation if required, to
any child presenting with bradyarrhythmia and circulatory failure.
If a poorly perfused child has a heart rate